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~ NONTAXABI~ CE~T~FIC~~E AND RECEIPT
~ FOR ESTAYE TAX ~ ~J
, ~ TO: CHELSE~ TITtE COMPANY
` _ P.O. 80X 1~52
StUART~ FL 33494
RE: The ESt8te of 1t E R NER ~ 0 OR I S E.
. SoCial ~BCU~i~y No. ~ b 5~ 3 0~~~ 10
L?ate of Death; 0 8/ 0+~ / 8 6
Resldsnt of B~XAR County.
St~te of T X .
VaNdBtbn Date: 0 y/ 1318 T _
Issue ~tte: 0~/ 28 / 8 T
CERTlFICATE NUM6ER A A 35 5 30
THIS IS TO CERTIFY~ that in ~?ccordence with th~s provisions of Chapter t98, Ffo~id~
Statutes, there has heen filed with this office e swom rspor~ ar retum for Estate Taices as requir~d ~
by i~w, and on the basis therepf it has been ascerta~ned that the above ~atat~ is nt~t ~ubject to tti~ ` j
Fiorida Eatate Tax. The issuanc~ of this C.ertifirate~ howev~r. shall not _precfude the aesaesme~~ =i
and coliection of Est~te Taxes subsequentty detemrined to be due the Stete of ~icrida. _
If proof of nontiebiiity by the ebove Estate fv~ the Florida Estate Tax is requtred by a~y
p~rson~ thts Certiflcate may be exhibited as evidence of such nonliebility..
Qiven in triplfce#e under my hand and the Seai of !he State of Fioride.
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CLE~K
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