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In the District Court of the State of lowa, in and for ___~z1~~~ County~
In the M~tte~ oi the Estate of PAEWMINARY 1NilERITANCF, TAX REPOItT
1 AND PROBATE INVENTORY
THOMAS J• KAYENY l~~?~ No ~65 I~heritance No
~ Decedent's 3.3. No
Deceased Estste S.I. No
C;OMES NOW the undersigned. executor administrator trustee or other
Liat name(s). address(es). sip. • ~w~itr
rs~x~r F. Dsvis
and to the (:our~ nports as foliowa:
Name of Deeedent A~ ~t Date oi T~eat~te or
Years Besidence De~lh Inteatate
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~ COOk COL1IIt~T
Thomas J. Kaveay 55 tate OP illinois l~~?6 Te9tate ;
- ANSWEB ALL QUESPION3 ~
1. Designat~d attorney (name, address. siP. Pbone no.) .
James F. Drew, Waukon, Io~ra ~
2. Marital statns oi decedent st dewth: Married Widow(er) Sinale Di~oited
3. Wen any children born to or sdopted by decedent after e:ecntion oi L~at Willi Yes No (]Q In all eases oi adoption.
furnish copy oi decree.
4. Ha: Will been admitted to Probate? Yes No
Is a 1~vst involvcdT Yes No (x) If yea. fnrniah copy.
Is thia a regular administration? Yea ) No If no, is this a Clearsnce frnm Inheritance Tax Lien proceeding
(C.I.T.-Short Form) under C4de Section ~b022T Yea No If so. did tide p~ss bp Will. Code 3ection 633.306T
Yea ( ) No ( Intestate Yes ( ) No ( J in tenancy Yea ( ) No ( Tranafer by deed Yes ( ) No ( .
6. Decedent'a last oecupation Ane sthe st ~s~ _
6. Will s Federal F:atate Tax Return be filed for ihia eatate'! Yes No
7. Did decedent leave a aafe depoait box ~ Yesc- ) No~ )
lf y~,, g;~e ~a,t~~ Joint' with Mother, Waukon State ~gnk,Waukon, Iowa
Are sil contenta listed in this reportT Yat QC ) No O ~
If no~, explain ~rhy ~
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~ 8. List beneficiariea under WiU, heira at law. transferees and aurviving joint tenants. If any heirs are deceased. designate
! and specify respective peraons taking by represen~ation. Liat and specity if decedent left any heirs at law who sn not benefi-
i ciaries under Will.
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Age- Relationahip A~~~ ~~t7
Nsme y~ri ~ Decedent • No.
Mary F. Davis 75 ~ Mother Waukon, Io~ra 52172 483-34 -9369
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