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~~°~s«~ PRELIMINARY NOTICE AND REPORT
~ To ComotroNK of N~~ SreN of Ftoride
TALLAHASSEE, iLORIDA ~
Far All R~ddeut Esd~tes foe t6e Purpo~e of Debesrnaioina ~tate Tu Li~b~tity.
For AD Non•Resident Esb~tes Owniaa Rza[ Esb~te ~md Tinstble Peesood Pro~arty in I~7aicis.
To be Filed by Doiontdliuy Fa~a~ubrs cr Admia~tra~oes ~nd VeriBed 6ry? d~e judge af tbe tk~uaty Co~ut or
AclanowLedgal Befa+e a Notary P+uWic.
If tbe Estate ~s Retcn~naWe to tbe Faleral Govexnmeat, (70PY OF FEDI3RAL RSTURN, FORM 708y Should
Be Fikd w,tt611ds 08ioe On ar Befae Fifteen Montbs APoer Dato af Death.
(PLEASF READ CAREFULLY INSTRUCTIONS ON REVERSE SIDE)
IN COMPLIANCT W1TH THE PROVISIONS OF THS BST.~TS TAX LAW OF THS STATS OF
FLORIDA, CHAPTER 19~, FLORIDA STATUTES.
NOrTICE IS HEREBY GIVEN OF THE DEATH OF _M_M_
who died on tbe ~ day of ~ J~
r? ._._l~._, and who was a resident of
~ _ County, State of IFtprlds
______.__-----...------_____-------_~Appoint jj~pp~
(I-W~) lWu-wKel l8sa~toe~d~-I?~stor-eris)
of the Fstate of said deoedeat on the~
8~b._____.day of ~I~._ ,1$~~, by the
_ ___-_-_---~!~l~Y_ J~il~~~---------------Court of___._~i.a~t~a______~_County, State of------Flo~ida~-----------------
- - (~r Jadte's uc Othu Caut)
The decedent left an Estate both withu? and vv~thout the State of Flodda consisting of the following mentioned
items of property, the amount set o~ppos~te each being the estimated value thereof (show ~ rather thaq net value.
Deductions o~
r debis, liens, etc., will be reported only in a owmplete returr? in the event one is required to be filed.)
Real Fstate in Florida ( Give legal description. ) ;
B~ld with
Prcp~i'~Y in ~IaoaON Co~____.___----------_ 1s.16D. oo i ~olotlJ?
Pr ~P~~
$t'- ~4~ ~ ---------------___~l, ~~~-QD-i--~
_ rnaraa-~~----- - - i-----33,-~a0.-84-------
Tangible personal property in Florida (Copy Inventory attached) ~_____Y ~R--~--------,--
Real Estate not in Florida----------------------------------------------
Atl Other Ptoperty Whereves Sihutte: , ~
Stocics and Bonds-------- ---------------------------5 - ,
-o.----------
, , .
Mortgages, Notes and Cash---------------------- s-----~-~ . . ~ . . .
t- ~---------~•~6-----------
,
All other pmperty not classified above or belo~~.
Property owned joindy
(give legal description)----- ~ - ~-----------ro'------ -
: ,
Life Insurance for Benefit of Estate--------.--, - i-----------o------------------ °
Otber Life Insurance ; j
;
Trusts created by deoedent while livin8-------------- ~ - _:p..-__--------- ~
Ts~xable Transfers of Decedent____._--------------------- i ~r-_------------
List any ~ifts or Transfers maJe by decedent within three years---------------------- i_____~-4---•_-----------
(SHOW VALUE OF ALL ABOVE ASSETS) Torr~., ~~a..~.~- _
Did Deocdent at any tinne by will ~ othervvise euercise a limited power of appointment?___-----AI~--_------------------
' Dkl D~ecedent at any tiu~e trswsfear proPertY bY ~ercise of general power of sppointone~t?---------NO---------_--------------- `
L This Eatxte subject to ~ederal Est:te Tu ReturaY-_--_:_----,~_____.V___~_ -_.~._I1i~------------- _
ALL OF TAE ABOVS QUFSTIONS MUST BS AN
' ` . _
Ad~i~Ytr~taii ~
=we~-isaM~
i~io ~aas.~.w~ w..t. _
. ~ a.....~.~.Br'd~a~°o,--Flo~ida--_-
STATE OF-------FLOiRIDA----------•------------ ~1b05
CS.
covrrr~r oF y~uTSS---_-------_~_______________ j _
~~rner~ ~ -------~s snc a~? ~ .~a c~ ~~o~g
re~t~ef~iu~ dMt-~be sbts~nenb therein aontained are true tu the best of~_..._.._.~_~__.1mow3edge and belief. ~
Da~ ~ tb~~____._...day ~ D~o~m6~r ~
. ~(5~~+ ~ ~ 'j f
This must be ~eaocuted ~ - ~ , - ~ ~m.,-.i.,~an Ezp~es 4~, 1!A t
• • • • • report bY domic~ . e., .dm~pr Nw.~ivrM ~r~ ~ ~ ~ S
. ~ ~ i75 ~fi325~ - ~
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