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RAN~Y MILLER
EXECUTIVE DIRECTOR
STATE OF FLOR IDA 5~ 7w ~
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DEPARTMENT OF REVENUE
TALLAHASSEE. FLORIDA 32304 ~
NONTAXABLE CERTIftCATE AND RECEIPT
FOR ESTATE TAX
TQ: Chelse~ Tit~ e& .~ar~t~ ~ r,n,~._
8512 s. us ~~
TAomas A. Tivey, Spouse
RE: The Estate ot
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DECEASED ~•~/ `/ ~ ~
RESIDENT OF ~~,~
STATE OF
ivew Jersey
DATE: ~b
F 056Z1~
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COUNTY,
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 above estate
is not subject to the Florida Estate Tax. The issuance of this certificate, however, shalf
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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