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~~t~reby ~et~fy that on this day. beJore me, an oj(icer duly autl~orized ia t{?e State ajoresnid
a.~d t~ the County a(~o~:a~d eo ~~ka a~~~o~.~[edAR~en~s, pe?sonally appeared l;i'4 ,,~s-~1,..~C..~r
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to me known to 6e the person dea i6ed in and who executed tI?e /orepoing instrume~M, f~tyt~' ..,7~~,
acknowledged be(or+e me that executcd tl?e same. ~
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~`~I! my hnnd nnd oJJicia! seal in ll~e County and State last ajoresaid lhls ti
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'~-B 1 \"I'AA'(:IR1.I~: PF.NSONAI. PKnPI~:RTY ItF.CF:IPT ~ ~ ~
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O BE ISSUED BY THE CLERK OF THE CIRCUIT COURT OR COUNTY COMPTROLIER IN THE PAYMENT OF TAX ON MORTGAGE,
DEED OF TRUST OR OTHER LIENS UPON REAI PRO RTY BE DATE SUBSEQUENT TO DECEMBER 31, 1941.
STATE OF FLORID0. COUNTY OF ~ , ~ 197~
Obligee ~
~ TMIS FORM BECOMES w RECEIPT ONL
~ WHEN VALIOATED OY RECEIPTING MAGHIN O~
t~ OR SIGNED BY TME C.LERK. COMPTROLLER s CJ ti~
s OR AUTHORI2ED OEPUTY• AMOUNT PAID
} CONSIDE TI '
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TAY ~[i*t3T AR PAID TO F.NTTI'I.E ABOVF. /
nF~('RiBF.n INSTRI~~lF.NT TO RFCORI).
~ SFF. CIIAPTKR 799, FI.ORIDA t3TATl'TI:S.
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GLERK. CO M OR AUTHORKE~ DEP{JTY
! YM REGEI D AS CERTIFIED ABQVE
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