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• ..._.r+. STATE Of' F10RiDA
DEPARTMENT aF REVENUE
T/LLLAHAS6EE. FLORIDA 32.04 0
~ NONTAXA6LE CERTIFICATE AND RECEIPT
FOR ESTATE TAX
E7CEQR~iIE p~1ECT01~
T0: Richard P Bcgosian ~~.e Derosiers, .~oseph E
1418 21st St 11-29-79
V _,r?e Pe ch; Fla_ 32960 oaf Indian River ~y
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QATE: 3- Z l - S D
Cleo Derosiers, Spouse E 81787
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 reborn for Estate
Taxes as required by law and on the basis thereof it has been ascertained the ata~e estate
is rat subject ro the Florida Estate Tax_ The issuance of this certificate, howe~rer; shall
Trot predude the assessment and collection of Estate Taxes subsequently detJermirred m be
due the State of Florida.
If proof of ran liability by the above estate for the Florida Estate Tax is required
by any person this Certificate may be exhibited as evidence of such ran liability.
Given in gwdruplicabe under my hand and the seal of the State of Florida.
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Not value witfi~ot~~seal affixed.
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