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STATE OF FLORIDA
OEPARTMENT O~ REVENUE
..d1""~~ ESTATE TAX BUREAU
~ ~ TALLAHASSEE. FLORIDA 323Q~1
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C0~'R~ NONTAX/~BLE CERTIFICATE AND RECEIPT ~
Ex~ oieccmR
FOR ESTATE TAX
TO: Merle Ainsworth, Spouse A 4 3 4 4 2 P~
CibfJ Lawyers Title Insurance Corp.
9999 S. U.S. Highway 1
Port St. LUcie FL 33452 Re: Tl~e Escace of Donald W. Ainsworth
Deoeased.
Resident of t.ake'
~ COUnty, _ Tnd i ana
Date• 6~1 q/?~
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=5.00 Fee Received: 4/27/79
I THI3 I8 TO CEi~TIFY, That in accordance w?ith the proviaions of Chapter 198,
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M Florida Statutes, there has been filed with thia office a s~?orn report or return for Estate
~ Taaea se required by Is~? and on the bssis thereof it hae been aecertsined the above estste
~ is not stibject to the Florids Estste Tss . The ieauance of this certificste, how?ever, s~ali
~ not preclude the asseesment snd collection of Estite Taxea subsequently determined to be
~ due the State of Florids.
~ If proof of non liability by the above eatate for the Florida Estate Tax is required
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~ by a~y person thia Cectificste msy be exhibited ss evidence of such non liability.
~ Given in quadruplicste under my hand and the seat of the State of Florida the
~ date first sbove w?ritten.
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~ _ • ~ Ezecnt~~e Di ctor
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: t. Depsrtment of Itevenue ~ 4 9 0 51
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~~,~~~~?~3~ ROGER POITRAS `
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~ _ . , ' CLERK CIRGt)~ r~1Q~~ '
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~ Not ~al~d withont seal affized .
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