HomeMy WebLinkAbout0952 Fb'"I-ATE, TAX FORD[ d Prescribed b7 Tax Commlasloner _
REVISED DEC. 1977 OHID
ESTATE TAX CHARGE .
Posy In ;r 33~ 10 Date ---.....Fri,...... r:.....?.1 19.:.:..»
t~~~tate ------------------~i j~ :-:;:°:a:-.~.~..t...J;:.i: Probate Case 1\'umber :.=-u - _
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n:ite of Probate Court Filing Notice _........_.r.;1::::: ;:..~I.7.. ~ ~~^!k-__... Date T~uc Commissioner's Deficiency ~
Assessment
F.esident Return, ? I~Ton-Resident Return, ? Amended Return, ? Other
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Tu the Treasurer y• #
r..__t-_-----------------•-------------•-----.._.. Count .
I hereby certify that we have been notified by the Probate Court of ~-.t.:~~'s.::? s.--------..--.----------------------------____
t.ount}- of an estate or additional tax liability, or by the Tax Commissioner of an assessment as indicated above '
I.a}•able as stated below:
- - - -
Tb41 Amount
f PAYABLE BY Date of Death ~ Tau Assn-wed Inttreat ~ pe p~
i
- 1 i a7g
I ~n .
~cecutor or Admiuktrator' ~ ~ ~
or P~CL1tiOgQ
!,,;str~lnrtion of Tax• y to State I certify the above statement to be correct as of
f u Taxing Districts lrl the this day only. -
i"iiu~~-ing percentages
- - _ COUNTY AUDI'T'OR
a3-.i_i~'~ t
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c.~;:;1.21, R.C.) ~ -
CALVIt~ H~.11ChIP!`~
RECEIPT PRORATE .1!
,
i.eceived this same da}• from the above named part}• and estate the amount due of
to be placed to the credit of the undivided estate and inheritance tax fund.
x x
~ _ ~
. H County Treasurer
E-' (5731.33. R.C.) F'-
~ Certified to the Probate .Court of x ~ ~
~ County. ~ ~
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