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`~r.~~'° pRELiMINARY NOTICE AND REPORT
_ Te Cow~~Mollt~ ef MN StoN of Florid~
~ TAI.I.AHASSEi, iLORIDA
For AD Raddeot S~te~ for d~e Aupose af Deteemioin~ ~s T~ Idability.
Fo~ AII Non-Re~ideat E~state~ Ownin~ Real Esta~s and Tan~ibk Pe~soo~l Propeiir ia F1o~Ws.
To be P1Ued by Do~oo~iliey Faecn~ocs or Adnoini~ra~ ~nd Ve~iBed by tbe judae af t6e Camty Coart cr
Admowledsed Befae a Notary YaWic.
ff t6e Fsb~te L Rst~uaabie M t6e F~deral Government, OOPY OF FSDBRAL RSIVRN, FORM 70a Shou4l
Be Filed whh T1~ OlRos Oa or Be[ore Fif~een Moat6~ Aker Da~ee af Deat6.
_ (PLEASE READ CAREFULLY INSTRUCTIONS ON REVERSE S1DE)
. IN COMPLIANCS WITH THS PROVISIONS OF THS ESTATS TAX LAW OF THS STATS OF
FLORIDA, CHAP'TER 19~,, FiARIDA ST/~TUTFS.
NOTICE IS HEREBY GIVBN OF THS DSATH OF ~D
who diod on tl~? ~~y of ~°r 19 and wlw wat a resideat of
DroM._._
a~d _County, Staee of.~_._._~a'~ ~
~ J08EP!! ~ Molti0llM xa~ APpointed -
(I-W) (~Y~s-Ws~) . R~a~-~.
~ ~ s~~ ~ ~a a~at~,t ~ a~e aay ~ ,19..~., by ~
- co~ a ----.~_co~c c~c~?, sa?~ ~~as
tco~.a~ 1•al~., a~ oua c,o.iii .
ZbE ~dEC~CDL iC~ 8fl StAt@ b0~1 N/j~li 8~ Wi~lOllt ~10 $~~Q Of ~O?~A OdDS~l$ ~~IQ fO~OW~IIg IREA~OIICi~
ii@mS O~ p~'Op~ty
. t~1C aIDOUIIt E~ Opposi
t0 eacb bCiiig t}l@ ailitqat~ V~110 ~~S~WW ~~Qfi Iittlle! ~IAII DCt V~tle.
Deductions ~ debts, liens, etG, arill be ~rirepc?rted onty 3n a oo~plete return in the eveat one b roquired to be filed.)
Real Estafie 3n Florida ( Give legal descxipdon. ) - ~ :
4! Lats s i 6. D.~_ 60-.~ st~~ t~it t
. Plat ~oolc 11 ~ pa~ 11, -Mblf a 1t~ao~rd~ of at. Lqai~ Co~rt~~ Fla.
~~d ieintl,T ritb saac~ri~ ~po~l~ ; 1Z.000.00
•!l~at t i _~0.,,~.a4_
Tangble personal P~P~Y ~n~~ l~~ Inventory at~i~e ~
Real Fscate not in Florida i x~
AU Ot}~er Yraputy Whaevas Situate:
Stodcs and Bonds__._____~ =-1fpN
' Mortgages, Notes and Cash_.iLi~l3aStrl~L_.3a._~Otf~_ Casb O~.d~ _=4 i~Q____.:~
.
; AU otl~r property not classiBed above or below ..195~ Caai~la~ C_~ _Auto. ~;------:-.500.00
Pr°Perty °W'°ed jointh' ~
(give legal descxiption)--------------------------Sw-aDe~!i--------
~-------FJIED._A[1l Ec ~RQEB-K i-------------------------------------
`~-C ~0
Life Iasuraaoe for He~t of E:tate------------ . i___ 1~e._..----
Other I.ife Iasuranoe ~~M ~ ~ ; ~~ans
' ~ ' Naa~
Tn~sb cxeated by deoedent while living_________
lo ;
Taxable Transfers of Decedeni----------______-_ R 0 G t r.145105 ; KaN
,
List any gifts or Transfers made by decedent within ee years---g;:-l.U~.IE._G(?.U_i~TY~..__ a------ x~
F~oRiaa i~,~oo.~o
; ~sxow v~?i.vE oF ~.i. ~sovE ~ss~s) 1'~o'r~.. ~
Did Deoedeat at aay time by will or otherwise euercLe a limited power of appointmeat~ ~
Did Deoedent at any tinae transfer P~P~~Y b'Y ezerci~e af geaeral power of appointa~t~ Ko
Is This Estate subject to Federal Estate Tax Return?____________ _______________________________________R~.___~___.__.____.__
ALL OF TAE ABOVS QUESTIONS BS AN
r~e
~ ~ o... aaa~.
STATE OF _ ~'601tIDiA . :
~Ot~TT OF DnOMJUtD - : . -
OOUI~1'IY OF ~ _W ~~~:t~::u::~rr;
w'Pb lbK~o~n Y ~ ~ ~ ~ ~ ~ •
?_...._._._E' .`.Being by me first duly ~?an say tLst~._he ~ts~
report and tbat the stateaieuts thetein oontained are hvg t0 the bdt 1+ "~aw
' • " = r~--~
Dated at T+oert LatdadaL ~_----1ZtA _~y ~l - •
; ` . .
(SBAL) . ~ . < 1
~.+I/r-If.WS - , -
MA< 1~0 Notary Pu , State of Flnnda '~~l ~ .
E~ARRS My Com is~ion Fjcp~~ ~ lrnt~`i~;~
R~~ p~
j[}
j E~
p ort musf be e:ecuted b y domicili a r y e:e~~
y i q~ i~~~~~~~~
e _ 1'ii~,::..
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Fr. uu~p.~, F~
~i45 90
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