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STATE OF FIORIDA ~ R. "'a2
DEPARTMENT OF REVENUE
"'~"i'+%'~~ TALLAHASSEE, FLORIDA 32301
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~ ~ NONTRXABLE CERTIfICATE AND RECEIPT
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HANDY MILLER f OR ESTATE TAX
EXE~~'tITtVE OIRECTOR
~Q; Samuel S. Telep RE: The Estate of Cook, Ernest R.
2315- 54th Ave SOCIALSECURITYNO. S21-ZO-HOrJl
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~ ca.t-ad~-80631 DATE Of DEATH 7~16~H2
RESIDENT OF W-1 C~ COUNTY,
STATE OF Colorad~
DATE: S/6/83 -
F 87869
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; THlS IS TO CE RTI FY, 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 !aw and on the basis thereof it has been ascertained the above estate
F is not subject to the Florida Estate Tax. The issuance of this certificate, ho~vever, shall
~ not preclude the assessment and co(lection 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 ihe State of Florida.
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~ Executive Director
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Department of Revenue
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