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O. R,' 7 ~93 r'RECORO Mtl ~ 10:
BOOK ,j . . ~ La. Oft1". ,ot:
PRELIMINARY NOTIC~ AND REPORT B.B..08XOWI'Z
To CoIIlptrolJ. of tl!e f\tat. of PhrIda 8& c.9a1lmoMr " Rena., 201 Hollywood Bl<!g.
_Borth Young 011'01$ :
T~~.FLORIDA Ho111Wopd, 11or1da :
For AU Resident Estate.. for the I'\u.-- of Detenabtiq ERate Tax I.IaI!oOK7.
For All Non-Resident Estates 0waI.q Real E8tate-ud....T1utIible PenoDaI ~ ill Jl1It....
.. .... To be Filed by Domielliary Executoh or Ad.u.J.traton ad Verlleclltr tM J.... ~ lite Coatr
Court or Aeknowledred Before a Notary PubUe. '___.
If the Estate Is Returnable to tho} Federal Govemlllent., COpy OF FEDERAL RETURN, FORM 101,
Should Be Filed with This Of:i~ On or Before FUteea MOIltha After Date of DeaUa.
,,~-=c-_~=cc-- "---.
(PLEASE READ CAREFULLY INSTRUCTIONS ON REVERSE SIDE)
I~ COMPLIANCE WITH THE PROVISIONS OF THE ESTATE TAX LAW OF TIlE STATE OF
FLORIDA, CHAPTER 198, FLORIDA STATUTES.
NOTICE IS HEREBY GIVEN OF THE DEATH OF~. Q_~_~~_lt!lu."__OOMIUL.____..
t;nte _ ...IM
who died on the _ 14'\h_ day of_________ JUA'-__ ___ -----.----.------_________19_6Q.., abd who waa a resident of
.:ro.&1"4. _ _ ___County, State oL___,_.1orida
:::~~j?,~~~h.:::hftr)..;:;_~~d~=:~~..~-..--,CJOUR8U
of the Estate of said d~ent on the..______________day or.,._____,_,___._ _ .'.__"._.'_'__ __...____., !9,__._,., by the
'----- -- -.
_ _ ___ ... -- Court of _ _ _ - .--...--------.Count7, State ~,___.__________u___..._____ _:_
(Cou17 J....... .. ~ Ooout) --
The deCedent left an Estate both within and without the St.ate (If Florida eonai8tin,&' of the fol1o~ men-
tioned items of property, the amount IW!t opposite eac~ the estimated value thereof (show fI'08I
rather thsn net value. Deductions for debts, liens, etc., will be reported only in a complete return in the
event one is required to be filed,) -
Real Estate in Ftorida (Give complete leaal description.) ~.
CLot~.B,1100k 37,SUlf!'AKlD ..eAIU>Bl!8 ,P~___9-,. Ps~_:-_~lL,~_t.~~,~~~__ _'
oun.", a., vaoe.. an~. . . . . . . . . . . .' .. . . 1,200.00
Lot 15, - Block 19,--'ELWYI'-P:!RI:~-"P/B--'-5-'- Pil--;--Ii;--Iro_r~f-'--
County, 'lcr14a( 65292.W .24 - st.. W-.H01-~-,-P1t-&. d '-~l'--.-- '--9.550.00 '-'-.
Tangible pel1lonal property in Florida (Copy Inventory attached) ~1~~-'---- $--.-1..000...00_\---
Real Estate not in Florida_.,___.._ .--, .-___________ .__________.___.___.________.____ -- $_ ,---..--.0.00- ___
1"C""W....e.-....
..ow.lIt.v. C .....0)
VALUE
All Olher Properly Wherever Silunle:
Stocxs and Bonds_.__________________._____________ __________ __ __ _____________
Mortgages, Notes and Cash_____._____________ _' ______._.____ _________________.______.__
All other property not classified above or below________._______________.__.____.__.________..
Property owned jointly or in tenancy by the entirety, with right of survivorship, (except
such part thereof aa may be shown to be economically attributable to the sur-
viving owner). ___&b~._ ~.AtJ.X'.1ba.d- Z.8U--})rOP4tr".-.-----------------
Life Insurance fol' Benefit of Estate_____________ ___ __ ____. ._____ ..______....______._____
Other Life Insurance. .MARY ~.!...9_~~S~...~j.p_'.:.101&r,)" ..._________.._____
Trusts created by decedent while living______._______.,_ _____________________________
Taxable Transfers of Decedent_____ _ ____________ _h___ ________._____
$----
$------ ..
$-
-(hOG--- -
O.OO~--.
~.OO -.-
'--- -- --- --0-.-00--
$---------.--0-.-00- .-
,.____~OQ. 00
,
~ ",IV...~_'
,'t'----..,..,...-..~--.
" ., ~
$ --.... -lema
$.12.m.DD-- --
TO"{' AI.,
Appraised nlues_ Yea No%.
Estimated values Y~.A.1: No
, ,
ESTATE subjt!ct to Federal Estate Tax Return, Form 706, if iT088 estate 1.~60,OOO,Otl ot'c:ivef'. .~- .
ALL OF THE ABOVE QUESTIONS MUST BE ANSWERED
(If no valu~how none)_-__. ____n ____._______.___.h______._ _:.__.___.______ h_W__________.____._
- tDe.~
l!iI~ 'ofsD-*?~Jj"~~=----~SU"IY1l1C
'. . Spou..
6529 5.W. 24th St.W. Holl11'ODdt___~~_~~~~___.____
---------------
PM 0M.e _......
STATE OF
COUNTY OF
JlLORIDA
BROWAHD
-----~-:~J sa
IlA.RI Ep CO\JR8E. Being by me tirst duly 8worn 18__.- thaL.__heh _______--.-.read th2 foregoing
rep~rt ;me: ,that thf:,8t&tements therein contained are true to the OO8t of____..1' _m knowledge and beliel.
t~~ .at2-u,' Hi>1l.twood. llor1da . th'I5ih~ of.. .~. ~~tm~u;-' 1~
. : (SEA,L) ~------ -- -~ lA~---
.). - ....
- ~ '--- "_~,, a t. Ci or at Large ~
. ',; Thb rtport lIIut be eucllUft by clolllkilIary elE or ~traWr'
(\. Jta2; PUblic, State 01 f1ond.l at ~r
."" \.. ~...Q.-\..- ) 8oW'bmllliO"_ [xpjr<< Aug. 3, 196r
y Amtfieeft S~ty Co, of N. "I.