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Form C?R-30S ~ v1 Hwaav L. Coy. Ja.
Rtv. 10/77
tx~CYT1Vt DIa~CTOt
FINAL CERTIFICATE
INHERRANCE AND ESTATE TAX
STATE OF FWRIDA
TAi.iwttwSSeE NO. A lsoas E.T. '
I
TO; Re. The Pilate of Andrew Mandas
Katherine Mandan
Deceased.
Sxec. Bergen
Resident of
Paramus, Nea Jersey COT New Jersey
•
10/12/77
Date:
6/14/75 {
Hate of death:
THIS IS TO CERTIFY, That in aoo~rdance with the provisions of -Chapter 198, Florida
Statutes, there has bean film with this office a sworn retwn for Fatale Twee as required by law
d t e amount of tan assessed b the State of Florida t said
w the above named Pilate an tha th y aguns
i
~vae FIFTY FIVE AND 95/100
. Dollars 55.95
It is farther eert~fied that the following pa~menta have been made in fall aettlcment of the
estate ta: assessed against said estate:
February 19, 1976 $ 5.00 Tax _ ~
March 29, 1976 $ 50.95 Tax
$ 55.95 Tax in Full
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and that no refund of such tan nor and portion thereof has been authorised and that no claim
~ for refund thereof is pmdir.~
~ Given in quadruplicate Hader mf hand and seal of the State of Florida the date first above
written. !979 DEC 28 _lIM ~ OS
s ~ }TRASH-
COUR~
ocCO~n ~1r.r~ l~ E~eCUtlilb ~ r
4`7()82'7 nepartment aE Raeaue
Not valid without seal affised.
~ I HEREBY CERTIFY that the above is a true and correct Dopy ae it appears from the re -
cords of this office. s
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Ihi~ 1P,~.g.;~IEREOF, I have hereunto set mT hand and the Beal of the State of Florida
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' Y'~'V~~`s`~~` Lil Smithlinq, Cus i of Records
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