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I, r t 1;.: RlCI-IARD P. B?tINKER
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'87 ~T 19 A 8 :d9 RE: The Estate of • ' ~ ~ ~ ~ , ~ ~ ~ ` . , .
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Social Security No. ' : ' ` ` " i
FI' ' : i. - Date of Death: _ ~ _ ~ - ~ ` '
DO L',. Resident of County, ,
ST~ ` State oi ' `
Validation Date: ~ ` ' ~ ~ ' :
' Issue Date: ' j ~ ~
`
CERTIFICA7E NUMBER ~ = '
~
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, and on the basis thereof it has been as~ertained that the above Estate is not subject to the `
Fforida Estate Tax. The issuance of this Certificate, however, shall not preclude the assessment j
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, th~s Certificate may be exhibited as evidence of such nonliability.
I~ Given in triplicate under my hand and the Sea! of the State of Ftorida.
! ~?~o vr F~o~.
:;our~ty of aade 1 • ',`~Sti~ ,
~ .t?e?eby Ctrtfty thf~ do~c~rnw,~ .
- 9 tri cOpy Of th@ OrIg1R8J ~
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~ ~ TH~ s4`±'il, ~ r~ ~ ~ - _Q~.~-Qf~Y
` _ _ ~ RiCF~~XRO P. BRfNKER ~
_ - rk Circ tt Cou?t
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~ _ _ RANDY MILLER EX[C VE DIRECTON ,
~f ~ ~ ~ • ~ '~Y._~` ~ ! --t-+~_,,~ DEPMiM NT Of REVENUf
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