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IMY M. MI
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• s STATE OF FLORIDA ~'~aS~L.
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DEPARTMENT OF REVENUE
~"04~4 TALLAHASSEE. FLORIDA -32304
- NONTAXA6LE CERTIFICATE. AND RECEIPT
RANOr MILLER FOR ESTATE TAX
EXECUTIVE DIRECTOR
T0~ Frauk 8. Fee, IiT, PA . RE. TIN Jack, Betty L.
PO box 1000 DECEASED 5/9/79
Ft, Pierce, FL 33450 RESIDENT OF Cuvaho4a ~~y,
STATE OF Ohin
DATE: ~21~,/BO
Datlniel A. Jack, SPouee
. E 77696
E 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 or 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 as evidence of such non liability.
Given in quadruplicate under my hand and the seal of the State of Florida.
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~ . < ~ ~ Executive Director ~
`'"1 ~ s't" De artment of Revenue 4 5916
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r ~ " ~ FILED AFDC fcGOntKD
'~~•y - ' • ~ ~ ST.LUCIE C4!.1tTY.fl
-j - ROGER FOITRAS E
• pIEBK CIRCUIT CO I
Not valid without seal affixed. ~ECC°h ~E`'^~`-~ ~ - -