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STATE OF FLORIDA •
, DEPARTMENT OF REVENUE ~
„d'""~'~ ESTATE TAX BUREAU
~ . 4~ TALLAHASSEE. FLORIDA 32304 ~~I~3 .
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""RR" c°~.'R. NONTAXABLE CERTIFICATE AND~ RECEIPT
ExccuTtve o~RCCTO~ -
F4R ESTATE TAX
To: y _ , . : r. ~ ~ - , E 214 2 2
~e._ ~ . 'r_~1.n•., _
1 ~ i.-~~..~ 5 '^~;T:~' -;:~r, -
. . ? r, ~ r, Re: The Eatate of . :
- . : „ • 5: 2 ~ ~ ~ . ~ ~ i _ T"1 } ' , } _ ~ 1 T"~ ~'h
a1~~7. .
Resident of :i ~ ~ -
County, r? n r~~-' 3 ~
Date: f ; ~
- :5.00 Fee Raxived: -
THI3 I3 TO CERTIFY, Ttist in sccordance ~?ith the proviaions of Chapter 198,
Florida 3tatutea, t6ere haa beep filed ~?ith this offiee i aworn report or return for Estate
Taxed sa required by law? and on the bssis_thereof it hae been ascertained the above eetste
~ ia not subject to the Florids Eatate 'f ax . The isausnce of this certificate, how~ever, shall
~ not preclude the sasesament snd collection of Estate Taxes subsequently determined to be
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~ due the 3tste of Florida. ~
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~ If proof of non liability by the above eeiate for the Florida Estate Tax ia required .
~ by any person this Certificste may be exhibited ae evidence of such non liability .
~ Given in quadruplicate under my hand and the sesl of the 3tate of Ftorida the
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~ dste fisst sbove written. ~
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' • /lLE04M0 RECUROEG~ '
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~ Not ~alid withoot seal affized . ' ,
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