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Form DRJ08 STATE OF FLORIDA
Rw_ t/e0 DEPARTMENT OF REVENUE
SNE s7,
~4 TALLAHASSEE, FLORIDA 32301 !
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•''4p'"``~• NON-TAXABLE tERTIFI~ATE AiID RECEIPT
Randy M8lar fOR ESTATE TAX
Exaartiva Dkaetor
TO: Regina Theisen, Exec. E 02505 ~
C/o Chelsea Title and Guaranty Co. ,
8000 South U. S. 1
Port St. Lucie, Florida 33452 -
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Rs. The Estate of Lousi Theisen
Deceased.
Resident of Montreal Coun
ty
Statie of Canada
Date: 12/23/77
55.00 Fee Refeived~ Same
THIS IS TO CERTIFY, That in afxordanf:e with the provisions of Chapter 198, Florida Statutes,
there has been filed with the office a svrom report or return for Estate Taxes as required by law and
on the basis thereof it has been ascertained the above estate is not wbject to the Florida Estate Tax. The
issuance of this certificate, however shall not preclude the asseument and collection of Estate Taxer .
subsequently determined to be due the State of Florida. ~
If proof of non liability by, ttt$..abwre _s~tate for the Florida Estate Tax is required by any
person thin Certificate may be exhibited as evidence of wtdt non liability.
Qiven in quadruplicate under my hand and seal of the Stets of Florida the date first above
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Exawtiva Diraetor
Department of Raranw
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Not valid without seal affixed.
HEREBY CERTIFY that the above is a true and correct copy as it appears from the records
of this office.
IN WITNESS WHEREOF, 1 have hereunto set my hand and the seal of the State of Florida
this 30 day of April , A.D.19 80
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1SE,~14?l.)
Custodian of Records ~
Lil Smithling
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