HomeMy WebLinkAbout2425 'IVE DOLLARS (~5.00) FEE case No. 7~t-3399
Form DR-301 Brot,tard County
Rev. 7-01-71 ~
PRELIMINARY NOTICE AND REPORT
TO: ESTATE TAX BUREAU, DEPARTMENT OF REVENUE, TALLAHASSEE, FLORIDA, 3Z30t
IN COMPLIANCE WITH THE PROVISIONS OF THE ESTATE TAX LAW OF THE STATE OF FLORIOA,
CHAPTER 198, FLORIOA STATUTES, NOTICE IS HEREBY GIVEN OF THE DEATH OF
Decetlenl's hrst name and miAtlle ~mtul pecadeot•s Nst eame Oate ot deatA
Vi'I~.R~~ {i • ~`~i~
Res~ifenu (dom~ule) at tlme of dcatn ,45 ~t Wc Ae~t owned rul prop«ly In
:
t. P•• , 1~3tnit~.:~Cs 'S51?3 ^t.~ie c«,~~y F~o.~~
Name. T dle,
ar
~a~r~s of at~utror~, a~dmimitrstp. W PlrsOn m P~sst6tiOn Ot dtceMnt's Drop~rty ;
vGir i~ X~ ~
5~5 t~~satt R~aa~ci, ~t, ~tui, i-:izu~ota 55123
Name and~d ress ot_*~ orney estate _
:~i~~~1613, One i~inaa~ia2 ~-la~, :'t. Leu~a, ~l~rida 3339~
i~ estate n be~n9 a0mm~stercA qIw trtls anC location o1 court and Aa e o1 oint ase ta ve
f cos,nty cowrt, prouste Divs~fos~, ~i.ie ~fo. ~9ia~~', ~n'k~or.a cowlty. Asinr,~ota
~ J i3{~{T~G1bQr 19?~+ • al ~o Anc-i 1 1 ar-z P rs f om Sr~t~rard Count~, Dat-ed i~PC~ _ 4, 197~ F
Y
The decedent Iett an Estate both w~thin and without the State ot Florlda consisting of the following mentioned items of
p?operty, the amount set opposite each be~ng the estimated value thereof (show gross rather than net value. Deduct~ons for debts, -
i~ens, etc., w~11 be reported only in a complete return in the event one is requ~red to be filed.)
j Reat Estate ~n Flor~da (Give legal description oi all real roperty in which decedent owned an interest) -
~ t~e..hsl~ tuters3t in Lo~ 18, Bgoclc 3. ~ StT~ET 2~sANbRg,
{ a~c~ ~~s ~~1ati ~tl~~o~ ~s~vctva~'+d~d~ X . lori
.cla.~.
$15t504~!OOt
Z~a. . PtiP~l.~c .liacw~ds . c~i . ~~c~!~r~. Co4tnt . . . . . . _ - • - - . .
~
~ a.~! On~-hal~ i.~terer.t ia La~ 13, Black J53, PC~i? 3~1'. LtICI~
~
~ ~~0~~ ~ ~ a ~ ~ivis~aii ~aacoi~d3.iiq~ ta ~Etie ~ ~iat' ~'i~oruo~ . . . ~ :
r~aa. ~n. pia~. ~Z.- -o~ .~~.o. . . . . . . _ _ 3~ao-Sos
-o8ia -ooo/y
~ F~~ca.--~ of: S~. Lucia Ca~tuty, I'losida $1,04J•00
~ y 16~,Q40,00---
~ (Continue on separate schedule ~f necessary)
~ ._:1+~.:
ang~ble personal property ~n Flor~da (Copy Inventory attached) ~'t~~ 540.~
~
All other Property Wherever S~tuate:
_ _ .16., 500, 00_ _ ,
~ReatEstatenot~~Flor~da .
~ ~Stock, bonds, Mortgages, notes, and cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.?.? 00 • 0~, . ?
~ InsurancP on decedent's 1~(e and Annwt~es . _ . . , . . , . 1,~.000 . 00. .
~ J All other property mclud~ng, but not I~m~ted to, ~o~ntly owned
property (other than real estate) and Power; of Appo~ntmenl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 00- , =
:
~ ~ Transfen dur~ng decedent's I~fe . . . . . . . . . . . . . . • • .
~ TOTAL S 43,7Q0.0~
Is Th~s Estate sub~ect to Federal Estate Tax Return~ NO
~x
i. t-''~~~~C '~`~'r1`'`" ~ hereby ack~owledqe under oath that I have
€s:
y.j ~name ot E xecutor as de~~neu un tnc reverse s~ae)
~ead the forego~ng report and that the staternents the.em conta~~ed are true and that the same correctly d~sclose all ot the
~ al5ets of the decedent named therein wherever located to the best oi my knowledqe and behef.
~
t~~~- ----------~---.......A+dministrator,..CTA
~ (Oate) (S~gnature) (T~tle)
St~te ct -1 _ ~o -
~ County of ~~.1~ MC Pl "W .
,
- . . . ~n the State and
Sworn to and subxnbed before me this ihe. . . . . . . . . . . . . day of . . !4 ~ . . .19. . . . .
~ County aforesa~d. •
kuu~uauN?~?WILLIAM SEL'tZ ~ • °
Notary Publit
~ ~p7A~r voBUC ~ MiNNESO~R
Y WARNING! Fadure lo c bla sp ~q, e r11 wlll sull ~n dNaV~nq the ~swante o/ h pr t~ht~tl. 11 ~nappHCab!!
~ or none show "NONE . H~~~''r~ ~ ~ ~A
,q., . ,.~~.R~p~t~~ BOQK~~ 1'ACE •t
FivE aOLLAR !55,04) (ee req~~~edlst~R'e iuuance ertificote.
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