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STATE OF' FLORIC~A a~~p L~_ ~ 3~/L~
p DEPARTMENT OF REVENUE Y ~
RR~iieb ~ 7~ O~ g TALLAHASSEE. FLORIDA 32399-0100
86~310 ~
Randy MIller NONTAXABLE C~RTiFICA~E AND RE~~iPT
Executivt+ DireRor
FOR ESTATE TAX G ~
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RE: The Estate of ~ D A~J ~ F~ H Y ~ L I S F. !
Social Secu rity No. -12 - 4~ 7 ~ i
Date of Death: y ` ~ ~ ~ ~
Resident of ~ I~~' T a~` County, ~
State of ' ~
Validation Date: 1 1/ 1 b I ~ 7 ~
Issue Date: 1?_ / 141 7 ~
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i,ERTIFICATE NUMBER A~649r,4
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THIS fS TO CERTIFY, that in accordance with the provisions af Chapter 198, Ftorida '
Statutes, there has been filed with this office a sworn report or return for Estate Taxes as required ~
by law, and on the basis thereaf it has been ascertained that the above Estate is not subject to the `
Florida Estate Tax. The issuance of this Certificate, however, shall not preclude the assessment
and collection of Estate Taxes subsequently determined to be dus the State of Floricla.
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.
` Given in triplicate under my hand and the Seal of the State of Florida.
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~ : ~ ~ _s~ '87 DEG 28 P12 :0
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~ ~ - ' ' _ ' ~,L~Q :"~!=fj . ~ , r'iANDY MILLE EXEC VE DIRECTOR
T DOUGI.a~ (i;l: DEPARTM NTOFREVENUE
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- ~ W~~ 12/14/87
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~ 6~0~569 PA~~ 975
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