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pRELtMtNARY NO~'ICE AND REPORT ~~Si
T~ C~o~te~o11K of N~ S1eN of Fio~id~
TALLAHASS[E, FLO~IDA
For AU Residaat Estab~ far tbe Purpose af Dater~a B~tste Tas I3abiL'tp. ~
Far All Nan-Resident Fststes Owains Rwi Iishts snd Tac~gtb~e Pa~sooal Propaty in F1o~rida.
To be Fikd by DomisifL•y Fsecuto~s o~ Admh~stra~ocs ~od Va~iRed br tbe jud~e af tbs Cawty C,ouRt or
Aclawwle~lged Befare a Nota?y Pub1tG
Tf t6e Esht~e Is ReturaaWe b die Feder~l Gove~rnmart, 00?PY QF FSDB~RAL RIs"1"GTAti, FORM 70a SbouW
Bs Filed witb TId~ OE~3oe On ar Before FiEteen Mond~s Aker Date af DeatL.
(PLEASE RBAD CAREF[ILLY INSTRUCTIONS ON RBVSRS~ SIDS)
IN GOMPLIANCT WITH ~1'HE PROVISIONS OF THE BSTATS TAX LAW OF THS STA'TB OF
FLARIDA, CHAPTER 198, FLORIDA STATt.'TES.
NOr1TCS IS HERSBY GIVSN OF THS DEATH OF ~ ~~R p~~~
who died ~ the.~ 16 day of~._._.._ Dl~~ 1S~.t~._, and who was a resident of
~1~e~tchsttsL' _Cuunty, State of ~~.1~1 Yorlc _
_ ~ ~aa _wAppointecL E~c~cvtor
~ ([-w.j (W..-w«.i (~e~vlor~-Ad~i~
of the 8state of said deoedent on the 8 _day oE. ~#A~ ~__._...,19 by the
$utr'sogato' a.-----------------____Court of_ yi1s~~~hl,lt~__.Caunty, State of----_~L__YQtk__.~.---------
(Go+~.er l.aseY's « o~ti.r Com.)
Z'he decedent leh an Fstate both within and without the State af Florida oonsuting of the following mentioned
iteans of paroperty, the amount set o~ppo~te each being the ~ted value the~reof (show groas rather than net value.
Deductions Eor debts, liens, etc., will be reported onty in a complete return in the event one is required to~ be filed.)
Real Estate in Florida ( Give legal d~scription. )
Land in S+actions 4 and 5 of To~n~bi~ $7 South. Ranae
3? Ba~t, Tallahaaat~ IMsidian. Luci• t~ynty, ~lortda
ccwsa accurat~ly d~~cribad iu attachad E'~chibit 1~?. 14, 000, 00
Tangible personal property in Florida (Copy Inventory attached)~ ,i~O~i!_--___---_-
Real Estate sot in Florida_,___----~.___-----------_-------- ;~__~._5.Q4L.,QlZ_----
All Othet Property Wberever Situate: -
Stocks and Bonds_------__-
- i-----non~
Mortgages, Notes a~i Cash---------------------------- i--- non~
All other ProPedY not classified above or below ._~~IlQI1~1__8f#l.C.tt _jc__C1QthiIICJ;--------- -.,~_$Q_..OQ---------
Property owned joindy
've 1 al descxi hon DOl~~
~ P - - ;
Life Insurance for BeneSt of Estate--------.- i--------no~le------ '
Otber Lafe Insuranoe~~ _ 3
;---7?-IIQQ.-QU_------
Trusts created by decedent wLile living--------- nnn~
~I Tazable Transfers of D~cedent__________ _ _ =tone _
' List an~• gifts or Transfers made by decedent within three years--------- 5----------AQ.*1~-------------
(SHOW VALUE OF ALL ABOVE ASSETS) TOTAI., ~~,1.f.Z5Q~pD.__---_ '
Did I~ecedent at any time by will or otherwise exercise a limited power of appointment? ___.__AQ_.___________
Did Decedent at any time transfer property b;? ezercise of general power of appointment~______----------~~---------_----- ~
Is This Fstate subject to ~edrral Estate Ta: Return?------------------------------ IIO :
; ~r~.. oF ~~ovE QvFSriox Mvsr sE wxsvvsxga
,
~ - ;
~1 lt~r s ptiill ps, J__ _ _ ._1 _ .
~o P'bil~p J. Mill~r -
407 Lincoln_ Road1 Mi~i H~a~h~~,j~~~c~~---------
~.e oir~ aaa~.
STA'I'E OF_----,~ISTi~ rOR1C____~~----------------------• ~
SS.
COUNIY OF-___.~~R '
MAI11'i~t T. PBII.IaIPB ~
ge~ by me first dWy sworn say~_ '~_~e__._~hA~ ~ead the foregoing
report and that the statemenb ~ein cnntained s~re true fio the best of ~ ---~--_Irnowledge and belief.
Dated arl~it• P1iin~...~;..~GJ.,,ay~ffie-----~Q------~Y ~ ~ - , 19_F~FL. ;
YOTARY p~~UG. S~~TE ~;F ~iEY+ YJRK / . •
~S~I,~ No. o,-7i 114;0 t
~
Qustiiied co~ ~~r~S~E~ co~~~. ^~/3 Iadw- A~61ic
Ie~m fxPil~s'!'~~h 30. 1968 d
i
This rrport must be e:ecvted by domici~ e adm' wrv~vv~a spou~
dGt~~.J~ PAGE
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