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. w . . . . - _ ~ , . ~ , . 1.~32 p ' 'ib I'rclimiru~r°y Inhetil~nco 7`ax lteport CI~11~1610~ IQ/7J - _ ---~:s_~__ - - - - - ~t'tt}:nUl.h ~:-1NVl~:NTO1tY UIr JO1NT PItUI'F.RTY (3how grou vRlues ~nd namca oi wll joiot tenaots). Sce inetruclione io ~chedules A and I3. I~~ciwle ~cccued interesl. li ownetship br ~urvi~ar i~elaimed. lurnish atfida~it oi eontributb~. ITEY (Deaedptioa) • VALUg Thomas J. Kaveny or Mra Mary Davia Waukon State ~ank Time CertiPicate No. ~5859 ~ i~2o.0~ , ~ i ~ - ~ ~ ~ ~ ~ ~ ~ ~ ~ . . 267 ~ ~ 2~D TOTAL (aLo ent~er on Paes Y) ~ i 1120.06 EBe~c~ oi ' Thomas J. Kaveny SCHEDULS-s . ; ~