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RANOY MILLER
EXECUTtVE OIqECTOR
STATE OF FI.ORIDA
DEPARTMENT OF REVENUE
TALLAHASSEE. FLORtDA 32304
NOHTAXABLE CERTIfICATE AND RECEIPT
~ FOR ESTATE TAX
TQ; Title & TrLt Cn_ ef Fla_
PS-4061
fiE: The Estate of ~Iartzell,, Harr~ F_
DECEASED ~..I.~~f-+~
~.~' - -4t' - 33452
Jean M. Hartzell, PR
RESIOENT OF ~~~
STATE OF
OATE: }~~ ~
F 08223
COUNTY,
THIS IS TO CERTIFY, That in accordance with the provisions of Chapter 198,
Fiorida Statutes, there has been fited 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, 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 th~ seal of the State of Florida.
,
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Executive Director -
Department of Revenue
51~8
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Not valid without seal affixed.
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BOOK J~ ! PAGE 2?48
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