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~!:1t1rUUL)•: L - 1'ERSUN-.-il. EXE~11'1'IUNS
;lntau~k atrx?uat set off or s]lowetl under Sections '1115.13 and 2117.20, Revised Code.) _ ^ - - -
See St•t:tiun 331.15, Revised Code.)
l~antr and Address of Lkoeficiary AKe ~ Relsta?nslup .trttouat i
None
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CAl.VlN 1'1. hJ~CHlNS
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~CHEDlJ1.E ~I - RECAPITI,'L:1T101 _ - - _
Scttttlule Cans Estate Total Value on
1).ttr of Ihatl~
A Beal Property
- S
B Stocks and Bonds - - 4
C ~-fortgages, Notes and Cash .'j~r Z7 4 d7 '
D Insurance - - - - - - - - - - `
E Joint and Survivorship Property . - - - __~2F257 s 92 ;
F Other ~[iscellaneot~s Property _ _ _ 300.00
C Transfers During Life Time _
H Powers of Appointment - - - ,
1 Annuities, Pension, Retirement Plan _
Total Cross Estate _ - S~11, 400-r83--
Declaration
~SeMion 5731.22, Revised Code, provides a maximum penalty of =1,000 for failure to file a return. if failure to file or any
unclcrpayrnent is dt~e to fraud a maximum penalty of SI0,000 is provided.) ~
I declare that this return including accompanying statement(s) has been examined by me and is to the best
~~f my knowledge and belief, a true, rnrrect and complete return made in good faith.
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6-24-74 ?~Lf`~~~.~,~ ~L~r~ t~ r:t~-~? 1031 Project Avenue
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natr Sisnature of Fiduciary od Ashtabula, K4'1!`iro 44004
Other Person Filins Return
Declaration of Attorney or
Other Person Filing Return
[ declare that I have prepared this return for the person(s) whose signature(s) appears above, including
~ttly accomp:lnying schedules and statem~•nts, and that it is, to the best of my knowledge and belief, a true, cor-
rect anti complete return based on all information of which I have any knowledge.
_6-24-74 P.O. Hox 267 Ashtabula,
D.te Sisnature of Preparer Other Than Addres~Oh l0 4 4 0 0 4
Fiduciary, or Other Declarant Filins Return
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' BO'JK343 NacE11~6
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