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~ . ' STATE OF FLORIDA ST tUC
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DEPARTMENT OF REVENUE ROCEq pp~jR~S ~
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ESTATE TAX BUREAU '`aK `;'p"„'T
TALLAHASSEE, FLORIDA 32304 ~ ~ `
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, Eo s*p~~N~ NONTAXABLE CERTIFICATE AND RECEIPT
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FOR ESTATE TAX ~
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, _ _ D 4008
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Re: Tl~e ~tate of ~ ~ - - - • ~ '
Deceased.
Resident uf • - -
County, -
~ Date: ~ ~ -
$5.00 Fee Received:
THIS IS TO CEBTIFY, That in accordance with the provisions of Chapter 198,
Florida Statutes, there has been filed with this office a sworn report or return for Eatate
Taxes as required by law and on the basis thereof it hae been ascertained the above eatate
is not subject to the Florida Estate Tax. The iasuance of thia certificate, however, shall
not preclude the assessment and collection- of Estate Taxes ~ubsequently determined to be
due the State of Florida. ~
If proof of non liability_ by the above estate for the Florida Estate Tax is required.
Ii 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
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date firet above written.
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~ ~ Executive Director
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Not valid without seai affixed. . z, ~
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~ EXHIBIT "D"
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~ 284 a~ ~~3 ,
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