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~ STATE OF FLORIDA
DEPARTMENT OF REVENUE 34(~21~~
~ ~ ESTATE TAX BUREAU
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? ~ TALLAHASSEE. FLORIDA 32304
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1 FO STRAUGNN NON - TAXABLE CERTIFICATE AND RECEIPT
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FOR ESTATE TAX case No. PR 29605
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Re : The Estate of . - - - , - . . ~ E
Deceased .
Resident of :'rai::~F '
County, ~j'=
Date: -~:~v ~
r.:. :~tzAU Fee Received: -v~~ ~':~r ?Ct, 1 :
THIS IS TO CEftTIFY, That in accordance with the provisions of Chapter 198,
Florida Statutea, there has been filed with this of~ce 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 assessment and collection of Estate Taxes subsequently determined to ~e
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.
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Executive Director
j~~'~ f~~ Department of Revenue 34Q21.~ ~
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