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. ST~i4-~f~AF FLQRip~4
DEPARTt+1~ENT OF REVENUE ~~~~~36 ~
~ ` ESTATE TAX BUREAU _
' TALLAHASSEE. FLORIDA 32304 '
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1.EOSTRAUGHN NON-TAXABLE CERTIFICATE AND RECEIPT
E7lECUTrvE dNECfOR FOR ESTATE TAX
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::f~L. ~`::::i ,clit~~~'.'~ i_:.~:y. C 95693
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~ N R,e : The Estate of ~ ~ ~ - ! ~ "
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° ~ i~. ; Deceased .
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Resi~lent of ' ~ ~
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j THIS IS TO CEBTIFY, That in accordance with the provisions of Chapter 198#"_~;;; i
( Florida Statutes, there has been filed with this office a sw?orn 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 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 be exhibited as evidence of such non liability.
Given in quadruplicate under my hand and the seal of the State of Florida the
date first above written. ~s?7~6
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~ , ~ Ju~-i1 12 43 PM'~~xecntive Director
• : ' Department of Revenue
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~ ~~~!r1AL REC~~t~
Not valid without seal affixed . f'~~ ~/~1 ~ 3
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