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STATE OF FLORIDA
OEPARTMENT OF REVENUE
ESTATE TAX BUREAU
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~ = ~ TALLAHASSEE. FLORIDA 32304
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""RR" w~.'R. NONTAXABLE CERTIHCATE AND RECEIPT 4~
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FOR ESTATE TAX
TO• ~
Mrs. Agnes F. Johansen , Spouse E 2~~~~
C/0 Mrs. Agnes F. Johansen
5504 Melville Road
Ft. Pierce, F1. 33450 Re: The Eacate of John Johansen
Deceased.
Re~ident of St. Lucie
County, Florida
~ Date: 10/ 2 3/7 8
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~ =5.00 Fee Received:
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~ THt3 IS TO CEBTIFY, That in sccordsnce w?ith the provisione o~ Chapter 198,
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~ Florida 3tatutes, there has been filed with thie office a sw?orn report or return for Eetate
~ Taxes a~ required by law and on the basis thereof it has been ascertained the above eatate
~ is not subject to the Florida Eatate Tax. The isauance of thia certificate, how?ever, ahall
a
~ not preclude the assessment and coltection of Estate Ta~ces subsequently determined to be
~ due the State of Florida.
~ If proof of non liability by the above estate for the Florida Estate Tax is required
~ by any person thie Certificate may be exhibited as evidence of such non liability. .
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~ Given in quadruplicate under my hand and the seal of the State of Florida the
~ date ficst above ~?ritten . ~
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~ Executive Di ector
:r Depsrtment of Krevenu~r 48 AM'~~ : i
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= :T.lliC!~ COJhSY.fIA.
ROUER POITRI~S
~ CIENK URtt?~T C4Y
't~ ~ REtOR~ YE~1i~E0
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~ Not •slid withont seal •ffized . 4~'z~`~~
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