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That the nature a~d value of the ~roaerty of the decc~lsed, Thelm~ a~MeDonou~;<:
who, died on the lTth day of __January , 19~, as near as can 6e ascertained at
the present time, are as follows: ,
Name of Institution Addre~;~ Check One ~ ~
. . • , . . . . , ~ ~u l l . . . . . . n
1. Deposits First Union Nat~l. Bank Cor ? iua C . 1.662_Q~
2. Deposits First Union Nat ~ l. Barile X ~5,43_3-. 51
`C~i'~i-zens'"S'a~:
dc"~"o
an _ 1, 02 . 0
3. Deposits F3r~t IIniQ,~o~Ne.t~~ Ba~_
4. Deposits dm~r,~$g~1k_ Sl~S~~-~-IIauid~- ' ~
~or~ at~r~ B~ Charlotte ~ T
5. Stocks and on s~nc u ing ointly held) ~
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6. Cash and uncashed checics on hand
7. Hause:~old furnishings - estimated market value
8. Interest owned in any business ~
9. Insurance payable ta estate ~
10. Insurance payable to individual beneficiaries $
11. Notes and other debts due deceased e'
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12. Farm products, lives[ock and equioment ;
13. :totor vehicles - estimated market value ~
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14. *iiscellaneous personalty - estimated market yalue ~
15. Real estate owned by entirety (include one-half value) ~
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16. Other real estate owned and located in North Carolina -
17. Real estate located outside :3or[h Carolina .~',90_00'
TOTAL APPROXIMATE VAI.UE OF ALL PROPERTIES:
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Sworn to and subscribed before me this '
lsfiay of Feb2~l~rv , 19_..~$ ~l ~ - - ~i'
Signature of _plicant
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" Box 101, Cornelius, N. C, 28031
MailinR Address
~ ~~j~ Clerk f Superior Court ~
% Deputy
' . Attorney ~
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_ t~ailing Address ~
Certified copy of this application mailed to the Departm of Revenue, Inheritance Tax ~
Division, Raleigh, North Carolina, as required by G.S. 05 22. ubm~t three copies to ~
the Department of Revenue.) ~ ~
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This_ lst dav of FebrU,arV,_! , 19~. ~ , ' ~ ~ ~
~ Deputy ~~~~Cle of Suaerior Court ~
G.S. 105-22 , G.S. 28-1, -6, -8, -29 MecklenburR ~
AOC-L Form 2 ~ County
Rev 10/69 ,
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