HomeMy WebLinkAbout1262 form OR301 4
~ Rev.9-01-72 pR~~~MINARY NOTICE AND REPORT 2~ '
TO: ESTATE TAX BUREAU, DEPARTMENT OF REVENUE, TAIWHASSEE. FLORIDA.3230t
IN COMPLIANCE WITH THE PROVISIONS OF THE ESTATE TAX LAW OF THE STATE OF FLORIDA,
CHAPTER 198, FLORIDA STATUTES, NOTICE IS HEREBY GIVEN OF THE DEATH OF
Decede~t's ~int namt and middle initul Decedent•s last name Date of de~tn .
PER.IlM~ r0y P. 8l~.I11A Mp~~ A~~ ff9T3
Residence (OOmiclle) at time oi deatA Oecedent owned real property fn }
f
eole 1i. R. sr A..... li.rr L.~.a . sl.r1~.. s~ Z~IIe~• co~~~y. Fi«~a,
Name, TitN, and addreis ol axecutor, administrator, or D~rson in posseision of tlecedent's p~operty
Name and address ot attorney fo~ estate
~ts a. sa~ea~an, Ar~r., t~ a. ~.t r+.ra t...e.N.i•. n•~ia.. ~
~
11 eslate ii being adminislered; give title and location of court and date ol appointment as ~eDresentative ~
~ ~~/fi!'+~~~~ ~~~MR
The decedent left an Estate both within and without the State of Florida consisting of the following mentioned items of
property, the amount set oppusite each being the estimated value thereof (show gross rathe~ than net value. Deductions for ~
debts, mortgages. and liens, etc., will be reported~only in a complete return in the event one is required to be filed.)
Real Estate in Florida (Give legal description of all real property in v?hich decedent owned an interest.) C~~~~~ ~~!"0~1~
H1~ek "e"~ Lt b~! UO'LIDA! OOt 1T !!t. I~iCIE~ s CadMiair~ res~rti~ i~ ti~ D~el~f~t
t~iri~[; ''r:oii~t ' i~ `ot~Yeil' Aio~rdi~ 8iik~ Id9~ "i~~ Fa~i' Iii~; "it 'Ii~ ~'I~blis R~e~r+~ ~t
~.-L~e.i~-Cwsl~•
'
;
~
'
~ -
~ s .s,eoo.os..
~ (Continue on separate schedule if necessary) ~
~ Tangible pe~sonal property in Florida (Copy (nventory attached) . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ ~M. . . - - - • . ~
~ All other Property Wherever Situate: THIS INSTRUMENT PREPARED
- AND TO BE RETURNE~ TO~
~ RealEstatenotinFlorida ..~M..--•-----
ENNIS R. SH~~~HERQ ' ' ~ ~
Stock, bonds, Mo~tgages, notes, and cash . _ . . . _ • • - • • • • s~0•$,- W: Fi~d •AvNtu~. • • . - • - - - • • - - • • ~
Insurance on decedenYs life and Annuities . FOft I.wd~14 Ho~id~ 333N ~~~0~~~ ~
All other property including, but not limited to, jointly owned X~M 1i~1~ ~~ry ~
property (other than real estate) a~d Powers of Appointment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ _ _ . . . _ . . . . . . ;
Transfersduringdecedent`slife ;
~ ;
~ TOTAL $ 'r~~~~~
~
~
~ Is This Estate wbject to federal Estate Tax Return? ~
AOIiAI.D PRl~1l(~iG~
° hereby acknowledge under oath that I have
~ ~must be fignetl by persoo qualifying under FS. 198_O1 (2)~
~ read the foregoing report a~d that s enu th ~ c ined true and that the same correctly disclose all of the ~
~ asset~~he decede,pL~ZmecLt~ in re er lo ted `~~t o y knowledge and belief. ~ ~
~ !M1'f sQw~ ai~ ~ r ~ ~1~
~ - • - • ' (Date) . . . . . . . . . . . . . . . . . . . . . . . . ' ~yl~naturel'~ - • . . . . . . . . . . . . . . . . . T~tte) . . . . . . . _ . . . ~
~ Stateof ~.ORZDA ~ ~ ' ~ ~
Cou~ty of ~ ~ • ' " ° ~ ' -
~E t~ ' t c
" Swwn to and subscribed before me this the . . . . . . _ . . day o~ . ~b . . . . . . . 9 . . . . - . . in the te and nty *
~ afwesaid. " , • a
3 t
~ - rI~10ii~ ~ f ' ' ' ' ' ' . . . . .
~ '
~ WARNING! Failure to complete aH blank spaces ~n the above form w~N rewU.~n.detey+c~g tl~t isswnoe of the proper ceruf~cate. tt none
~ show "NONE". ' . ' - .
. t.~,- ~ . ~ r ~ '.z ^Y
FIVE OOLIAR (56.001 fN rpuind for the iswaoc~ of s noo-nxable cadfiate: ' • - c~
sooN z25 Pat~ 1260 ~ . ~ ~ . . .
~
~ ~ , . - - - - - - ~ .
v
-~s. i
; .i
~ Q`=.:: ,
~ :r ~
7,._ . _ ....v . _ ,a.