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~ FormOR-301 FIVE DOLLARS (55.00) FEE
~ R".9-0'-'z pRELIMINARY NOTICE AND REPORT
TO: ESTATE TAX BUREAU, DEPARTMENT OF REVENUE, TAILAHASSEE, FLORIDA, 32304
IN COMPLIANCE WITN THE PROVISIONS OF THE ESTATE TAX LAW OF THE STATE OF FLORIDA,
CHAPTER 198. FLORIDA STATUTES, NOTICE IS HEREBY GIVEN OF THE DEATH OF .
Decedenl's ~?rst name and middle initiil Dec~dent's Iast name Dat! o/ deal~ ~
1
GERALD C. GROSS May 7, 1971 '
Res~de~ce (domicile) at time o1 death ~ned real property in
St . Lucie
4200 Cathedral Avenue Washin on D. C. ~iaaoc~.v~e=c°~"'y, F'p,w
Name, Til1e, and address of exKUtor, sdministrator. or De~son in possession ot decedenl's prope?ly
B Gross, survivinR spouse, 11119 Anesbury Lane, Alexandria, Vir~inia 22308
Name and adtl?ess ot attorney tw estate
H Sutherland P O Box 1~ Vero Beach. Florida 32960 ~ ~
V Vllll
It estate is bein9 adminKtered, 9ire title and location ol court and date ot apDOintment as represe~talive
FStAte ri~t nrobated
The decedent left an Estate both within and without the State of Florida consisting of the following mentioned items of ~
property, the amount set opposite each being the estimated value thereof (show gross rather than net value. Deductions for~~;d~L
debts, mortgages, and liens, etc., will be ~eported only in a complete return in the event one is required to be filed.)
FIL~L' ~M~ ?'FCORDEO
Real Estate in Florida (Give legal description of all rea! property in which decedent ow~ed an interest.) ST. L~:CIE COI;NTY fLA.
an;,: ~ r ~ R~S
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_ . . PE~O~[! V:= '~D~+~
~ ..~s~-~-'=~•.•f~led-i~• the •o~~ice -of•tt~e• Glerk of •t~e• Ci~re~it-~ourt•of• St: •~~ie ~Ill~ ZO IZ 33 PH ~7~ :
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~ • - - • - - - • • Co~nt~; -F~o~ida; - it~• ~F~at -Book • •page • 4~;• -said• ~am~ • lying • and ~gi~O
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~ . . . . _ . .being• in• St. • Lueie • Co~rrt3~, •F~or;da. . . . . . . - - - • . . . . . . . . . . . . . . . . . . . .
s .5.,500.00..
(Continue on separate schedule if necessaryl
Tangibte personal property in ~torida (Copy Inventwy attachedl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s~~Q-.QD_
All other Property Whereve~ Situate: '
Real Estate not in Florida -•-•••nOne
Stock, bonds, Mortgages, notes, and cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • - - . . . . : . . . . . . . . . . . . 75II~00. _ _ ~
F
Insurance on decedenYs life and Annuities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ . 40, 000. 00
All other property including, but not limited to, jointly owned . '
property (other than reat estate) and Powers of Appointment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ . . . . _i7011@. . . . .
Transfers during decedenYs life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • - . . IIOII@ . . - -
~V TOTAL S 49,250.00
~
Is This Estate subject to Federaf Estate Tax Return? Nn
1, SUSAN B GROSS hereby acknowlecige under oath ihat 1 have ~
~must be s~g~+ed by person qualitying under F.S. 198A1 (2)1
read the foregoing report and that the statements therein contained are true and that the same correctly disclose all of ihe
assetsvi th~ decedent named therein where r~cated to tfi~best ~my knowledge and belief_
• ~ =r ~ . ! ~ i.!~.7.`~. . . . . . .~4~--.M~. . . . ~"`1:~ s!~'? _ . . . . _ . . . . . . Suryipir~g. w~dQW. _ . . . .
~ I~atel ISynature) f T~ tlel
~ State ot Vir~inia
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~ Swom to a~subscnbed belore me th~s the : . . . . . . _ . . day ot • • ~`J Y ~ - - . . . . _ . , 1974 . . . . . . . in the State arxl County
j~I e~co fiission ex ~res: . . ? ~ ' ~ ~ ~
y - 1- ~ P Ny~, ~,b~t~ -~~'S't~'~~ ar18 ' CBi~nty ' last
a Y RIOT@S81(~ .
l ~T1~R'rFa~Tu?e ~ c te bZar?k spaca m the above tam w~ll ~ewlt m delaying ~he itwance of the proper ce.uNcate. N none ,
show "NONf'%, - , 0 Q ~Q `
FIVE OOLLAR (56.00) fN tiquind fo~ tM iuuanc~ oi ~ non-ts~ablt c~titicat~. 800K ~-?~.?t7~ PACE ~
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