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STATE OF FLORIDA
DEPARTMENT OF REVENUE
•.`~"~E "'~4 ESTATE TAX BUREAU
~ ~ TALLAHASSEE. FLORIDA 32304 '
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""RR" coy. ~R. - NONTAXABLE CERTIFICATE AND RECEIPT
cxecumE oi~ECro~
FOR ESTATE TAX
TO: Stefan Haczka-Spouse A ~ ~ PP
449
MacMillan & Shear, P.A.
Savannas Shopping Plaza
1074 N.E. Commercial St. ge; The Estate of Rozalia Haczka
Jensen Beach, FL 33457
Deceased.
Resident of CuYali~ga
County, Ohio
_ Date: 10/12/79
=5.00 Fee Received: 9/12/79
THIS IS TO CERTIFY, That in accordance with the provisions of Chapter 198,
Florida Statutes, there has been filed with this office a sworn report or return for Estate
Taxes as required by law and on the basis thereof it has been ascertained the above estate
is not subject to the Florida Estate Tax. The issuance of this certificate, however, shall
not preclude the assessment and collection of Estate Taxes 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 this Certificate may be exhibited se evidence of such non liability.
Given in quadruplicate under my hand and the seal of the State of Florida the
date first above written .
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- Executive Di ector
t= ~ • ~ Department of Revenue
' ` ~ 4139
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Not valid without seal affixed. c~Eaxc~.:=~~~~~
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