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5.
That the nature and value of the proverty of the deceased, SRN j D FERRRL
who died on the 28th day of January , 1~Q, as near as can be ascertained at
the present time, are as follows;
' Check One
Name of Institution Address gull 3f
1. Deposits First Union National Bank Canto N $ 46.00
2. Deposits
3. Deposits _
4. Deposits
S. Stocks and bonds (including jointly held) 000, 00
6. Cash and uncashed checks on hand
7. Household furnishings - estimated market value _ X00.00
8. Interest owned in any business
9. Insurance payable to estate OQO.Q~~
10. Insurance payable to individual beneficiaries $
11. Notes and other debts due deceased
12. Farm products, livestock and equipment
13. Motor vehicles - estimated market value
I 14. Miscellaneous personalty - estimated u~arket value
I
{ 15. Real estate owned by entirety (include one-half value)
16. Other real estate owned and located in North Carolina 4 0,0 00.00
17. Reai estate located outside North Carolina 4 0,000.00
TOTAL APPROXIMATE VALUE OF ALL PROPERTIES: $$3, 346.00
Sworn to and subscribed before me this
l~ -day of MARCH 19 80. '
Signature of pplicant 'fit
i
P_ O Box 475
Hailing Address
- A ant Clerk of S pert r ourt
Ruri-n_n_ Smithy Tr_
Attorney
Sit i 1 l t 77 3 N_ Mai n St ~ Wa=np~-
~ ville~ N. C. Hailing Address
~ Certified copy of this application mailed to the Department of Revenue, Inheritance Taz
Division, Raleigh, North Carolina, as required by G.S. 105-22. (Su mit three copies to
the Department of Revenue.) I 1
~ Th i s_l~_day O f MARCH . 19 80 y ~ C
tart Clerk of S peri r Court
G.S. 105-22, G.S. 28-1, -6, -8, ~29
AOC-L Fors 2 . ~ 5
County
Rev 10/69
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Do not use this space ~ Do not use this s ace
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