HomeMy WebLinkAbout0253 . . . _ _ . _
~ ~ i
, ~ . . .
. ~ i; v V ~ .
A'CTACH ONLY 3CNBOULB3 APPWCABLS. It sehedule b not attAChed. atate NONR
A. Did d~~eeden~ ~t the time oi his deatb owu any real estate? Yes t~ ) No
I[ a~oa~pkb 3cheduk A ~nd iho*r total eatimated ~~Ine. Sold T Yes No i 35000 • A
If ;sist tenaner~ aee B. Zb ba wld! Yea No :
t
B. Di~ ~a+~dent a~ the time of his death owp aay stoeks or bomia? Yes (7L) No 20~5•0o B 1
If eompkte 3chedule B and show toW estiau?ted ~alue. Ii joint tenancy~ aee B. ±
G Dia da~edent at the time of bls desth ow~A any mortg~ges. notes. or caah T Yea (]C) No 112~.06
It ~ eomplete Schedule C snd sla~r lotal esRim~ted velue. Ii jotnt tRnancy, see H ~ C
D. Wss anp inaunnce on the life oi tbe decedeat payable W• deaignsted beneficiary ~
Named Benefiei~ry ~ ~591 • 3 ~
<X ) eatate ( 1 execntor or adaaaistrator ( ) truatee ( ) corpor~tion ( ~
I.ist fu11 value of ~?Il insutanee puliciea whether or not taxable und detail in
Schedule D. (Fedenl Form T18 WiU bs e~equired with Fiaal Inheritance Tax Return Pay~ble Lo Eatate ~ D
~rben required for Federal Retnro.)
E. Did decedent s! the time of his desth own say property as s joint lenant with thght of aurvivonhip?
Ii ao~ complete SchcJule S and sbow total ealimated ~alue. Yes No ~ E
.
F. Did dccedent at the time oi his death owin say property as no! nturnsble under any other scheduk? 500 •OQ
Ii so. coiaplete 3cheduk F•aad sbow tatd estimated ~alue. Yea (x) No F
F l. If inteatate~ or ekctan to talce apinat the R?iU, designste specific property in Schedule F-1 EXEIdPT
trom E:ecntion. ~ g_1 ;
G. Did decedent ttsnater sny propertr bp deed. gr~?nt, aale. gift, or trsnafer oi any nature in contempistion
oi desth or in which deoedent reitined life eatate or possesalon until deatl~, or to become eifective at
death. or without fnll eoasideratjon! Yea No (~C )
If so. complete 3eheduk G aed abov? total estimated valqe. ~ g
H. Did any other prnperty pass by reason of the exercise of po~rer ot appointment given to decedent by .
Wi11, deed or otlrer instrumenti Yea No (a)
If so~ proride copr oi po~rer, and complete ~Schedule H snd ahow eatiraated value. ; H~
I. Were there any annuitia~ wppkmentary or otl~er income contncts. retinment benefits, or penaion funds
receivable by decedeot or p~yable to his estate or a nsmed beneficisry If yes~ eomplete
Schedule I. i I
J. Did decedent have any property tocated ontaide the State of Iowe? T Yes ) No
If so. oomplete Sehedule J and sla~? total estiasated valne. 96f~}•~0
i J ~
Total Batimatrd Gmaa Yslae lOZ~0O.4.~. ,
_
1f eat~te sppears to be
tan-taxable, li~t debts: ~ ~`p~ ~ I~nranee Pa~sbk to
Named Beaefieia 54-59~.35
s~l~~~~~OU ry i
IIOCER P~~~R puRj 966t~. 00
fHK C1RCU~t ~ I,ess Non-taxsble Out of State Propert~ _ •
•:Ea,F~fU .
p~~'~1 Batimated Gross 9'a:able Yalae = 3a645.U6
APR Z2 ` 53 ~ 11tortsage BaLnc~ _
Tota) Debta (Est.) 5~0~.00
• E- ,
, Net Ta:able Eatate ; 33~45•06 ;
f
AFFIRMATION ' •
Under penslty ot perjary~ I(we) aifirm that thia report including any accompanying statementa have been examined by
me. and ia~ to the beai of my knowiedge and belief. a true. cornct, and rnmpleie rrport made in good faith.
~ Date (Capacity or Ztitle) 3i
gnatutea
~
r' . ' E]Ce CAt2'j.]C r ~ : • '
~ ~ . Ct ~ '
- B
~
VERtFICATION TO IOWA DEPARTMENT OF AEVENUE
INHERITANCE TAX DIVISIUN .
The underaigned Clerk of the_ District Court in and for said County, hereby verifiea ihat thia ia a true an~i complete copy of
the Prelimioary Report wnd lnventoty (or ~mendments) tiled in said eatate.
a ~ % ~
Dated thi ~ C ~~Z ~~day of 18
t
l/~N./~`^ s
l~ ~ ~'~.~GClii-n 4./Le~e~ #
County. ;
Clerk of the District Court (or Deputy) F
ESTATE OF , Deceaeed ~x~~/ / ~rE
° ~ 253 ~
R iN WiI.I. HAS IiEEN ADNITTED TO PROBATP~ t:t.i;KK MUST SENU COf'Y