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4'74109 ~
Fwrn OR-306 ti1'AT~ OR tRORIDA
Rw. ~oi~7 DEPARTMENT OF REVENlJE
~""r'~s t£8TI?TE TAX 6tJREAU `
4
s« ~ TALVINASSEE. In.ORiDA• 32944
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~-~~N TAXABLE CERTIFICATE AiVa RECEIPT I
. ;
HARRY GOC. JR. FOR ESTATE TAX
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TQ; Peter S. Jorgensen, Spouse It ~d368
Fort Piexce, Florida
Re. The Estate of viola Jorgensen
. Deceased.
Resident of St. Lucie
- - ~
Coanty~ Florida
Date • - 9/9/66
- _ s Fee Reusived: Same - -
_ $1.00 .
THIS IS TO CERTIFY, That in accordance with the prnvisions of Chapter 198. 1!7orida ~
6tattutes, then -bas been filed with this office a sworn report or return for Estate Taxes as
required by law and on the •basis thereof it bas been ascxctained the above estate is not sub-
ject to tbe_Florida Estate Tu. The iasusnce of this certificate, however, shall not prcelade the i
assessment and collection of Estate Taws subsegaently determined to be due the State of Florida. -
no~_:~iability by the above elate for the Florida Estate Tax is required by any
~
C~~r~ ~ may be ezbibited a evidence of each non liabilitj.
'+f' SY7 Y ~+J€`'~ ' ~ s~
;~~Giv ` _ licate under my band and seal of the State of Florida the date first abode
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4 x.'~~"r ~ 4'74109
- ~ - . 19~ JAN 28 MI il• 40 -
• ' ~ F E AIID REW 0
- - -
R£CfrRB VERtFIEO___.$ Ea,~ti~e or
Depsrtwent of Rerentre
Not redid ~?ithoni seal affized.~ _ ~ `
- -
IHEREBY CERTIFY that the shore is : _ tree and corr+at a~pl? as it appars f
ran the re = ~
.cords of this office..
WHEREOF, I have bereeyato set sty band and -the seal of the State of Florida
' ce~aber A.D 19 79 - .
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p' t` - Lil Sisithlinq, Custodian of co ds
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