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FORM O/t- ~02
STATE OF FLORIDA
DEPARTMENT OF REVENUE
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, ESTATE TAX BUREAU
~ ~ TALLAHASSEE, FLORIDA 32304
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J EO STRAUGMN NON -TAXABLE CERTIFICATE AND RECEIPT
EaECU1~vE O~REC~OA
FOR ESTATE TAX
TO: p~ilda M. Sample Spouse ~
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c/o Mr. Charles R. P. Brown, Atty.
P.O. Box 1418
Fort Pierce, FL 33450 K~~: TLe ~:.?atc ot ~
E. Frank Sample
De~~eas~~d.
Kc.i~lenc of St . Lucie
t:~~~~?~c~-, Florida
February 25, 1974
tia.llll l~ ce Kecei~-ed.
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 preclueie the assessment and collection of Estate Taxes subsequently determined to be
due the State of Florida.
If proof of non liability by the above estate for the Florida Estate Tax is required
by any person this Certificate may he exhibited as evidence of such non liability.
' Given in quadrupiicate under my hand and the seal of the State of Florida the
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, date first above written.
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Not val~d. wttita~~~ seal affixed . E';s 224 PAGf ~.55~
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