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FORM OR-~OI L~
, ~ STATE OF FI.ORIDA
• OEPARTMENT OF REVENUE
ESTATE TAX 6UREAU ~
~ TALLAHASSEE. FLORIDA 32304 _ -
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Eos~~~~. NONTAXABi.~~ CERTiFICATE AND RECEIPT
°'""T°" ~ ~ "FOR ESTATE TAX
TO: Doris A. Hartley, ,s~~se; D 21010
C/O Mr. Gerald S..=James, Atty.
P.O. Box 3089 , .
Fort Pierce, I~'L 33450 Re• Tlie Estate of
~ p~~. Clifford Hartley .
Resident of St. Lucie -
County, Florida
Date: October 21,1974
=5.00 Fee Receiv~d:
~ THI3 I3 TQ CESTIFY, Thst in~ sccordance ~vith the provisione of Chapter 198,
~ Florids 3tstutea,. there hss been filed w~ith this office a sROrn report or return for Estate
~ Tsxes sa required by la~v snd on the basis thereof it has been sscertained the above eatate
is not subject to the - Florids Estate Taa . The issusnce of thie certificate, hoe?ever, ahal!
not preclude the sssesament and collection of Estate Tsxee subsequently det~rmined to be
due the State of Florida. •
1f proof of non liability by the above estste for the Florids Est~te Tsa is requiped •
by any person thia Certificate may be exhibited as evidence of such non liability.
Given in quadruplieate under my hand and the seal o# the 8tste of Ftorida the .
date firs~-tafi~~~~.~itten.
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t•~~` Department of Revenue
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