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?A~ s.T.a•w~e PR~'~I.IIIZINARY NOTI('~~ AND It~PORT
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To Caaptrolkr oi the 31ate ot Florida as Coaamisaio~~r ot Re~eaae ~ 1.Ej1~,3
TALLAHASS~B, FLORIDA '
For All Resident Tatstes fvr the Puspose oi Detera~iains l~'atate 11UC Liability.
For A11 Nos-R~ident Ssta/ea Own1n~ R~al ~te and Tansible Pereou~l Property in F1orWa.
To be Fikd by DoniicUiary Tzecutora or~i~trator~ aud. VertH~d by the Jadge of the County
Court or Aclcnowkdged Before a Notsty Pub '
If ihe Tatate Ia Returnabk to the Federat Goverwnent, COPY OF FI~DTRAL RETURN, FORM 706, ~
Should Be Filed with This Oti~oe Oa or Before Fliteen Montha Aiter Date oi Death.
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. (NLEASE READ GARBF`ISI.Ll' INSTRUCTIONS ON Rh1'~R3T 81DE)
IN ~ COMPLIANCE VKITH THE PROVI3IONS OF THE ESTATE TAX LAW OF~ THE STATE OF
FLORIDA. CHAPTEA 198, FLORIDA STA~`[)TE4. ,
NOTICE IS HEREB~' GIVEN OF TAE DEATH OF-----VICS~It M. _~1171'Ai1Li1~1i~ -
~~~ho died on th~__l~ ._c~ay of.____!T~lp ____~_M____,.~___ ._.1~~__, sud who was a reaident of
---------lkrlit~qtaa.-_--------County, State ofr_______--- q~-i°~
Appointed---
~'0 _11D~8T~ti1Tt~ ~8J1RY .
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of the Estate of said decedent on ~he--------------------day of_._----------------------------------------_--:= , 19--------, by the
- Court of---------------------------------County, State of---------------------------------------- '
_~cw.v Joa~.. o~ Mr«~ oti..e?
The decedent left an Estate both within and without the State of Florida consiBting of the following men- ;
tioned items of property, the amaunt aet opposite each being the eetimated value thereof (ahow groas ;
rather than net value. Deductiona for debts, • liens, etc., will be reported only in a compiete return in the ~ `
event one is requin~d to be fl1edJ '
Real Eatate in Florida (Give brief~ legal description.)
, Jointly--a+nW _ vith wuvivia9--~poo~~ - . 03
- - - ''r ,
~ Lo~t ~loak 9, ~ 2~i~1Li ~ii1Qi ~Dto~?asM! Couaty~ ZS, 000.00 . -
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Lot 8, Block 16, i~DrRtO t~T *1 (8t. Iuei~ Co~u?ty) _ BO0.00 ,
,
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TangiWe personal. roperty in F`lorida (~Copy Invento attached _
P rY ~ _ - S - -
' . ~s - 1
Real Estate not in Florida_1?.OZ-x.---~t1~---At11ri~~1s-,-`1i. -~ja1At~._ .~..z~~_OQO~QQ- - Z
All Other Ptop~rty Whetever Sitnate: -
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Stocks and Bonda_-------------------------------------------- - -xO~i~------------- '
~iortgaSes, xotes ana Cash 8~nk_1leeouAt~__~JoiQt~ 3t0o0.00------,-
All other property not clasai8ed above or below~l9~' _4~At~11!____________________ g____~~OOsOQ •
Pro rty owned jointly with surviving apouse----------- • ~ltCMif b~f~ - ~
Pe
Life Inaurance for BeneSt of F.stste_________________ ~
lfiOM
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Other Life Insurance._________^------------- - i--------~.--------- ' ~
Truata crested by decedent while living---------------------------------------------------------------- ~
Taxable ~ansfers of Decedent-------------------------- - ~ .
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List aay giits or Transfera made by decedent within Rve years
TOTAL. ; ~SK~--~ a
Did Decedent at any time by will or otherwise exercise a limited power of a ~
Pl~intmentY_ ~O ~ ~
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, Did Decedent at any time transfer prnperiy by exercise of general power of appointment?.___~~_._.__________ ~ Z;~
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ts'I'his Estate suhject tn Federal Estate Tax Return? _ _ _ AO__ a : M w
ALL OF THE ABOVI$ QUB~STIONS MU3T BF. ANSWLRBD M o Z~
RETURN T0: I ~ ° "
. ~~r.s~~G~c. ~iv w~ ~,r' ~ < ~ ~
Sutton, James, 6ielejeski & Lunny -------;urv3- a9---- w<
1776 East Sunrise Boulevard ~ ° ~
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Fort Lauae~dale. Fb?ida 33304 ~
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Yo~t Ottiee Ai~~ar
STATE OF ~AUDi1---------------------------------------_--_ :
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UNTY OF _ s~~
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-----~~------------------•--------Being by me ttret duly sworn sa~ ~t----~---he------------ba-------~=~~~l~~s' ~y.
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report and that the statementa therein contained are true to the best of_______.__.hRr___ kno~ledg~e.~t b~,:~ ~
r ~
lwct L~via~sdal~ ZO ' s ~
natea at~_.__.--- ~ay ~1R~'~r " " - ~
- the_--•--__ of_--_____ . ~ . y ;
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Notary PuD11c. State of Florida at La 1„~~':
Thia report must be e:ecuted by do Y'n~b~~~q~~e~~~~i~~~ ~~~~~~ri~:NN~~'~
a40K1V0 PACEZS ~ ~
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