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STATE OF FLORIDA
~EPARTMENT OF REVENUE
ESTATE TAX BUREAU
TALLAHASSEE. FLORIDA 32304
Residcnt of
,. Eo s~•~~ NONTAXABLE CERTIFICATE AND RECEIPT
`t`~"~` ~"*~ FOR ESTATE TAX
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Re: The Eatate of
Deceased. ' ' '.
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5164f~9
A 28460 PP
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Date: • -~ . . -.
ES.00 Fcc Rcce~ived: ' - ~ "' ' ' ~
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THIS IS TO CEBTIFY, Thst in accordance ~-ith the provisione of Chapter 198,
Florida 3tatutes, there has been filed wit6 this office a aw-orn report or return for Estate
Taxes as required by law and on the baais thereof it has been ascettained the above estate
is not subject to the Florida Estste Tax . The issuance of this certificate, however, shall
not preclude the asseasment and collection of Estate Tsxes aubsequently determined to be
due the State of Florida.
If proof of non tiability by the above estate for the Florida Estate Tax is required
by any person this Certificate may be exhibited ae evidence of such non liability.
~ Given in quadruplicate under my hand and the seal of the State of Ftorida the
date firat above written.
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Not vslid w-ithout eeal affixed .
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Execut~ve Director
~Department of Revenue 5~~~~
~ FEB 10 at1 ;~ 59
f1iEC tNf ~~CGRliIC
SLLUCIF CCUNfY.i[ 1:.
ROGER f'OITRA5
CLFRY. CI^CUtT CGURiQ
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