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% 3TATE OI~ RORiDA
Q 5 0 4 4 3 DEPARTMENT UF REY~NUE
a. ~ves TALLAHASSEE. F~ORIDA 32399-0100
Randy M~~~ ~ ~ NONTAXABLE CERTiFICATE AND RECEIP~,__ :
Executive Director
FOR ESTATE TAX i ~ ~ ~
666853 ~ ~
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~ TO: ROBERT A. BURSON 1 ro ~
P.O. F30X 95-1b20
STUART ~ FL 33495 v ~
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RE: The Estate of CZEREPINSKI, BENJAMIN S.
~ , Social Security No. 098-24-7831
Date of Death: fl 4/ 16 / 87 ,
Resident of M A R T I N County~
State of F L
Validation Date: 0 5/ 2 8/ 8 T
Issue Date: 06/17/8T
! CERTIFICATE NUMBER AA420~6
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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, a~nd on the basis thereof it has been asc9rtained that the above Estate is not subject to the
Fiorida 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 nonliability by the above Estate for the Florida Estate Tax is required by any
person, this Certificate may be exhibited as evidence of such nonliability.
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Given in triplicate under my hand and the Seal of the State of Florida.
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~ - 844416
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~ ~ _ = _ _ _ I' ! ~.E G i;, . . p/WDY MILLE EXE DIRECTOR
~ - - - ~ = C~GUG~ A~. .
S T. L U C i E., ~ DEPARTM OF REVENUE
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~ : 6~~~ F~ar,Fi179 06/17/87
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