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FORM Oft- 3p2 ~ ~
STA~TE OF' FLORIDA f~
~ ' ` DEPARTMENT OF REVENUE
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ti „ ' ESTATE TAX BUREAU
~ o TALLAHASSEE. FLORIDA 32304
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J. ED STRAUGHN NON • TAXABLE CERTIFICATE AND RECEIPT
E7lECUT~VE O~RECTOR FOR ESTATE TAX
TO: t,ve~,':~ L. :~tY~is, ~rous~:
L:,-~~ .~oi~::.~.~ :,~:r~ C 85723
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~'1~:~~~:a~~~~~, t'.:u~~~.~3 ~J~ j~ Re: The Estate of .7cs;: ; ~ t~
i . :~wi. , ~.:r.
Deceased.
Resident of l'=~"E~ `1`~~
r' i c.~:: : a
County, ~
- ~ ::uv=_-;r:~: `r 3; ~
Dste : - •
$5.00 Fee Received:
THIS IS TO CEftTIFY, That in accordance with the provisions of Chapter 198,
Florida Statutes, there has been filed with this office a sworn report or return for Estate
Taxes as required by law and on the basis thereof it has been ascertained the above estate
is not subject to the Florida Estate Tax. The issuance of this certificate, however, shall
not preclude the a$sessment and col~ection of Estate Taxes subsequent[y determined to be
due the State of Florida.
If proof of non liabitity by the above estate for the Florida Estate Tax is required
by any person this Certificate may be exhibited as evidence of such non liability. ~
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Given in quadruplicate under my hand and the seal of the State of Florida the ~
date first aboye written. ~
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I~G SJ~ ~
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~ ~ ~ ~ Executive Director
Department of Revenue
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Not vaiid without seal affixed . ~
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