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,~v ~~~» STATE OF FLORIDA 511'72`!
' • ~ DEPARTMENT OF REVENUE
y`'..°~t~E ~''+q TALLAHASSEE. FLORIDA 32304 ~
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~~;.,.~,~' HONTAXABLE CERTIfICATE AND RECEIPT
RANDY MIILER FOR ESTATE TAX OR 651 PG 1159
EXECUTI DIRECTOR
TQ: Probate LeQal Assistants RE: The Ettate ot Henriksen, Arnold H
4O~ W. ZO~'1 $t. StE ZOS DECEASEO 1 1 f t f 79
SdI1t8 AI1d~ ~'-p ~ZQ~ RFSIDENT OF COUNTY,
STATE OF ~~~l~3
DATE: }~.~~{
Lillian Henriksen, Spouse
F 018?2
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 on the basis thereof it has been ascertained the atiove 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 tNis 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 •
Department of Revenue
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Not valid without seal affixed.
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