HomeMy WebLinkAboutOC1969-0173 - ESTATE OF NAUSIDASl3-fo r-/73 J
i\ffibuuit (@f Executor ®r i\bmiuiatrutor
~tatt of 'tntt8yluatlia }
<1tounty nf lIa84ington .68:
Personally before me,the undersigned authority,a N.Q.t.§..r.Y-P.JJlb.i.~in and for said
HELEN CHADA aLkJ H .1'.M'd .County ar.d State,appeared ,F.\........a..e..e.n...Re.e who,bemg duly
sworn according to law,deposes and says that She is the executor or administrator of the es-
tate of .MINN.IE...NAUS1.D.AS..:deceased,that the foregoing schedules constitute a
complete lnventory and appraisement of the real and personal estate of MINN.lE...NAUSIDAS.....,
deceased,except real estate outside the Commonwealth of Pennsylvania;that the figures opposite
each item of real and personal estate in the foregoing schedules are determined and stated by the
under~igned to be the fair value of said items as of the date of the decedent's death,based upon a
J.·':lst..~pp:r~l.·..s~m.e.nt of each item.made bY~heab named Ex~u~r .Administrator...'/.',v"..-ojJ .:9";'(2..........~now known as
,~.'~Sw~rn:lfr~s~ubsmbed before me tbis ~.//}'~?n;//.J
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."'...Notary P,u~ii:!:Monongahela.Washington CoADDITIONAL INSTRUCTIONS '
1.'"AIl'{h~:zITb¥Y iftPj~ll!>'~~il~lP within three months after appointment of 'personal representative.
2.•A'supplemental inventory must be filed within thirty days of discovery of additional assets.
3.1 Original and 2 Copies and 2 RCRI-34,Under $10,000;1 Original and 2 Copies and 2 RCRI-33,
Over $10,000,including Copy of Will;1 Original and 3 Copies and 2 RCRI-33,Over $50,000,in-
cluding Copy of Will and copy of Federal Estate Tax Return.
REFERENCE FOR ADDITIONAL COPY
Act of 1947 P.L.513 Sec.5.2,72 P.S.4844.2
.;.~,,,..
..3Jnurntory aub Apprai8rmtnt of the goods and chattels,rights and credits which
were of Min.nie N.a.u.s.id.as :late of N.ew'Eagle :.
Washington County,Pa.,taken and mfJde in conformity with the above affidavit.
f't'
ALL that certain parcel of ground situate in New
Eagle,Washington County.,Pennsy.lvania,known and'
designated as Lot No.205.,in the .Plan of Rive.iview
as recorded in Plan Book VolumeS,at Page "215,and
upon which Lottheie Iseiected a twb-st'ory frame'
DOLLARS
3,OOQ
CENTS
00
dwelling hOuse of .·!tliiey (3,)i:,rooms.See Deed date-d
August 19,1924 to Justin Nausidasand Minnie Nausidas,
and recordled in the'Recordei of Deed I s Office 'of
Washington County.,Pennsylvania,in Deed Book Volume
523;at Page 211.The'said Justin Nausidasdied on
July 23,1944,thus vesting all his right,title and
intereit :in Minnie "Nausidas bi virtue of h~r right of
survivorship.
....-5*.gLj-(P~~08
19 :.
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IN THE ESTATE OF
'13~
~3-~r--/'}3
Inventory and Appraiseme1;t .
Filed ,
HORMELL,TEMPEST,SIMMONS,
BIGI &MELENYZER
ATTORNEYS AT'LAW
223 Second Street
Monongahela,Pa.15063'
Clyde G.Tempest,Esq .
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J '7 /'.\',.;;.,;;~<~.Die \~\~~~.p~f~.rJ;;...NA~.?J:PAS.,....d~.~.~.a.s.e.d .....
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Fo;m No!RCC-62 (4-71)TfllS FORI!REQUIRED IN ALL E~TATES WI,TH GROSS ASSETS UNDER·~10,OOO.U!"DER SECTION 701 OF ACT OF JUNE 18.1881.J,~FUCTI':E IANUAR~/,1862.~'FILE I~DUPUCATE ~~TH COP~OF'WILL 'A~ACHED)"C?3:-10 1-/7 3,'
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OFFICE OF THE REGISTER OF WILLS
County of WAqI:I~NGrQt';J .
..1:f~.~~I:'J..~J:IA~k\.(I:I~.~~~.~:.,.~~~.~1 of,N.~w.Eq.g.l-~#••E~l1JlSY.l"ani.a .
(N'lIIIe)(Addreu)
being duly .s.W.Ql:IL _.according to law,deposes and sal's that he is the ..&dminis.tratrix __.(Exer..Adm.•Lesatee.Etc,)
of the estate of Mt.!!J.l,J~N.~1!~Jg.'iI:?_.whose last residence was ._.N~w.._E.agJ.~-~a:?hin.z.t.QIL .(No,)(Street)
C.Q_\m.ty.,...E.~.IJ.:!t~.Y.J.v.:§.Jlt~.....deceased,and that the whole of the estate of said decedent,who died..J.g..I.l."...9..,...l.~.9.~_reilY.Bo!Ough or Township)(Date)
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA.WITH STATEMENT OF MORTGAGE ENCUMBRANCES lTPON EACH PARCEL AT DEATH OF DECEDENT,
WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES.GIVE NAMES.ADDRESSES AND RELATIONSHIP OF OTHER OWNERS.
Real Estate Estimated
Value
ALL that certain nar:el of Q'round situaf'e in New EaQ'le WashinQ'-
ton County Pennsvlva.nia known and desi o-natp.d as f.otNo :U'C;
in the Pl;:m of RhTp.r',rip.w ;:)'"rp.rorilp.iI in Pl;:m Roo1c Vol C;P::at=>
215 •.and upon which Lot there is erected a two-story frame ewell
house of '[fh,r~e'e/Cb1)rooms.See Deed dated AUQ:ust 19 1924 tc
Justin Nausidas and Minnie Nausidas and recorded in the RecordeI
of Deed's Office of Washington County Pennsvlv:mi a in Deed Bk
Volume 523 naQ'e 211 The said Justin Nansidas dip.d on .Tnl v :n
1944.thus vestinQ'all his rip'ht title and interest i'n M;nn;p./-
Nausidas,by virtue of ber rio-hf'of "nrvivor"hin ¥y ~'0.00 00
~~I
!YJ/,"",,.A<vi.\'0 J
.
'''':C-~~
v'I \~I ~
Personal Property
"K 0 N E"
"
NOTE:You may expedite the processing of this return by filing with e,and as a part of the return,
letters from financial institutions or mortgage holders,certifying to amounts on deposit or owed by the
decedent as of the date of c.eath.Such letters must be signed by a respcnsible afficer of the financial
institution or mortgage holde:r and indicate clearly amounts of principal and interest in the decedent's
account at the date of deatt and the type o(account,account number and the exact name or names in
which the account is registered.•
Jointly Held Property Esti~ted''Vlilue
"-,
-
"N 0 N E"
o.r I "
,...•J o...,o'..'.~..\.'
It
-
Transfers within TWO YEARS Prior to Death
""N 0 N E"
".j~I
:,:J.I-
That at the time of death there was no safe deposit box registered ih decedent's individual name,or jointly with,or as agent or deputy of
another,or in decedent's individual name,with right of access by another as agent or deputy,with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Western p'P.n~~vl V::ln i a NaT hn::ll R::In lc M,..c Minni e Nallsi the:;F..n::lll O'h Tpr
Mono:ngahela,\;Pennsylvania Helen Chada
1 ~..,j..'-\1'......-.
BENEFICIARIES
e
o
ct
s ,
f I
Co •'BENEFICIARIES AND ADDRESSES
RELATIONSHIP SURVIVED AGE OF LIFE
(If step-children or DECEDENT TENANTS OR INTEREST OF
(State full names of all and their addresses who have illegitimate children STATE YES ANNUITANTS BENEFICIARY
an interest,vested,contingent or otherwise,in estate.)are involved,set •0 OR NO,AT DEATH OF IN ESTATE
forth this fact.)DECEDENT
,
Helen rh::lrl::l (Hpll=>n M 'R1"1"r1'1 InallO'hTer Vpe:;Real Est;:Ite sllhip
J to payment of ~
New Ea~le.Pennsylvania lj).l.,uuu.uu,payaDJ.
in pnll::11 cn::lrl"c T
Bernice Allen and
.M.Una .t'rances
"PrnnCT::ICT1;n
~~
Bernice Allen Daughter Yes $50.0.00 (as above
Donora,Pennsylvania stated)
Carol Jane Knouse .:I-cl::lllO'hTe~Vee:,.nT n-F .:I c::;1"11
~te •vlnNewton Fall
~nlo,no~a parr-o
Pc1"::It-1"
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\
_______~._~_._~_~_,_,~----~_...__~-------·~-...,."C-i
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RESW,ENT .DEC~DENT DEBTS AND DEDUCTIONS CLAIMED
NOTE:List first five items in the spac~s so provided,observe notations thereon,and instructions.
Funeral expenses paidFryeFuneralHome
.----.::D::...:E::..:B=-T=__=O:..::R~C_=L~A:.:.;IM~___,.-----..=.N:..:.A::..:T:....:U:....:R:.:..::E=--=O:..::F....:..::.S:..::A~M:..::E'----r----:A.;;.:M;.:..O..::....::..U.:.;N:..::T,....---!oTHIS COLUMN~EGISTERONLY
$1 029 00 $
Helen Chada (Reed)Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)1,500 00
SEE BELOW
ATTn1"npV
Administration Expenses •
Counsel fees •l~n 00
Helen Chada (Reed)
Administratrix
FiduciarY commission •150 00
OTHER DEBTS AND CLAIMS
(.)See Note below
Russell Marino,Reg.Wills Letters of Admirtistration 2/4/13 00
Guy Rogers,Letters of Administration 2/4/15 00
Russell Marino,
Washington Co.Reports
Monongahela Pub.Co.
Short Certificate 4/3/69
Advertising Estate 8/29/72
Advertising Estate 8/29/72
1 00
16 00
12 50
Clyde G.Tempest,.Esq.Preparing Quit-Claim Deed 30 00
Clyde G.Tempest,Esq.
C.M.DiGiovanni
REcording Quit-Claim Deed
Notary Fees
7 SO
2 00
Russell Marino,Reg.Wills Filing Inventory
Russell Marino,Reg.WilS Filing Account
:Thomas Scurfield,Ins .Agt.Insurance
18 00
3 00
13 78
:;9.9 ~
.35 -:.,00·.J
232 S9
Eighty-Fo~r Lumber Co.
Russell Marino,Reg.Wills
Hanna's·Home Repair,
Donora,Pa.
(1969)
Real Estate Taxes (1970)
(1971·&1972)Olga Woodward,Rec.Deeds
Kurtz Monument Company
repairs to House
Clerk's Costs
House Repair'
Real Estate Taxes
Recording Cert.of Real Estate
Headstone
S74
7110
73
88
Total $4 ,030 SlY 0 Jo.5',
Note:The estate agl'ees to advise the Register of Wills if the amount actually paid in settleJ:"lent of any fee,commission 01'debt is greater
or less than the estimated amount claimed and.allowed.X JJc~~,now known as
:S'~bscri~~~nd sworn to before me this :J.~...2~.m:~..."./.(Executor·Admm'lStrator)
...F.o.uJ:th.Av.enue , .
.(Stree=Number)
..Ne.w ..Eagle,..P.ennsy.lv.an i.a...1.50.67..
.(City or Tc·um and State)
Having been duly sw~~c~ording to law,I do hereby certifctt the above appraisement is made_in conformity with law on this
.................../.o...UsJ day of ~,~19.ft/;!".£",.~·······~~···J::7~.;)·········C;-"'I : ./App..uaer,
In the event that any future interest ir this estate is transferred in possession or enjoymert to collateral h~il's of the decedeflt after the
expiration of any estate for life 01'for yEars,,the Commonwealth hereby expressly reserves t~right to appraise'and assess traasfer-inheri-
tance taxes at the lawful collatel'al rate on an'y such future interest.
..~E~ORT OF T~E-REWSTER/~~I~S..
I,the underSigned duly elected Register of Wills In and for ..,',"~j~0<'''','.,,/.,e ty,Pennsylvania,do respectfully
report that I have allowed debts and deductions in the amounts daimed by depo~ept as to those items here a greater or lesser amount
is set fort~in the last column to the right:n said schedule above,which greater or lesser amounlre resents t s'Jm allowed as a dE-duc\ien.
Dated:Q.CT.~..~.J~?~~~.~~.~l.L.M~.~'~.....~.f 1.~~~.•..-_.Register of WIlls....
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Form No.RCC·62 (4·71)
Will -
Administration INo :year .
IN THE
MATTER OF THE APPRAISEMENT
,OF THE
ESTATE OF
.-..ML~NlE.NAUS.~DAS,.
-Deceased
Late of ...~~W .J;.~gle -....
County of .:W.Cl;~J:1j..~l1g:t.~If ...-n
--JCommonwealthofPennsylvania-J -
-£;0 ".c;:::3 ;--):'"rn c:c->l
(f>~(fl .-I ti\
REPORT ~~PPRA~Ar.;,.....-,rn ,..e::;::I "'--'~;or:
00."..Z-n>:v-a ~-;.rJ0_-;,~-u,Q
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HORMELL,TEMPEST,SIMMONS.,).
BIGI &EELENYZER
Attorneys at Law
Second &Chess Streets
Monongahela,Pa.15063
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'LAST WILL AND TESTAMENT
,,-of-
MINNIE NAUSIDAS=
\
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-~
I,MINNIE NAUSIDAS,of New Eagle Borough,Washington
County,Pennsylvania,being of 'sound mind,memory and unders:anding,
do make,publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Testaments or Writings in the nature
thereof by mz ,at any time heretofore made.
I,
I
I,
!I
FIRST:,I direct my ~xecutrix to pay all my just debts,
Ifuneral expenses and costs of administration as soon as may be con~
veniently done after ~y death;the money from my'insura~ce pOlicieJ
which my exe:utrix is beneficiary shall beused for this purpose.
out of the proceeds of said sale.
to Carol Jane Knouse,my Granddaughter.
All the rest,residue and rewAinder of my pTO-
FOURTH:
the same shall be situate at the time of my death,I devise
real and personal,of ~...hatseover nature or kind,and 't'1here-:
THIRD:I hereby devise my house situate on Neville Street,
New Eagle Borough,Washington County,Pennsylvania,to my DaUghter!
HELEN CHADA,on condition that she shall as soon as practicable,I
sell said hO·Jse and pay over to her sisters,BERNICE ALLEN and AllN1
.IFR~CES FRONJAGLIO,the sum of Five Hundred ($500.00)Dollars each:
!
IIherebydevisemyLotsituateinNe'tvton Falls,III!
I
IIOhio
IIIperty,
I soever
unto my three (3)daughters,HELEN CHADA,BERNICE ALLEN and ANNA
EMPE:ST &SIMMCNS
iECO"";O'&CH~SS STS.
MON·:'lr':GAHELA,PA.
,I FRANCIS FRONlAGLIO,
II
I
share and share alike.
. -~"t;tj~/_--~,---Testatrix
,
, I.
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1.
iI"",.~........,...._,~.-:--}~-------""~_...-""'"":~_.~....~.~..._~.~-_.._~-.-.......,'..
l_.'_:'.:._
,
'II.iIII·.SIXTH :
IHELEN C~DA,'to
I
. I nominate,constitut e and appoint my Daughter,·1
be the Executrix of .this ~y Last Will and Testa-
TEM?~ST a SIM~lCNS
SECON::)&CHESS STS.
,mente I direct that no Executrix herein named shall be required
to give bond in the proper administration of this my estate,or in I..
'the performance of any of the provisions of this my Last Will and
Testament.
SEVENTH:I confer upon my Executrix hereinabove named,
power at all time to sell any real estate or personal property,
which may at any time in her discretion be necessary from all or
part of my estate,for such prices,upon such terms,in such way
and manner,and for interest and estates as may be deemed wise,an
to make good dees therefor~to the purchasers thereof,without any
obligation on the latter to see to or be responsible for the ap-
plication of the purchase money,and to perform every act in the
"
management of like property owned by them.
IN WITNESS '-THEREOF,MINNIE NAUSIDAS,the Testa-
trix,have hereun~o set my hand and seal to this my Last Will and
Testament,which consists of three (3)pages,to each of ¥7hich I
have affixed my signature,this 1..J~day of ffi"v tTJ'1~3 e'R.
in the year of OUR LORD ONE THOUSAND NINE HUNDRED SIXTY-THO (1962)J
I
__.-J-J~~J /M/JiUddil"'-t_---...-(SEAL)i
Minnie Nausidas .I
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L_~:..--,._(~--..-~~/'-~"'-""'~'_~-----':"''''-''''''7'''''''---'.'~_~".-Il.~-"""'~.'."'__'!;'"'
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The foregoing instrument was signed,sealed,
,
!
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rUbliShed and declared by MINNIENAUSIDAS,the above named Testatrix,
IasandforherLastWillandTestament,in our presence,who,in
ber presence,and at her request,and in the presence 0'£each other
1lavehereuntosetourhandsasattestingwitnesses.
III,
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III .J
TEMPEST Ex SIMMONS
SF-CON!)&:CH~SS 5TS.
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RCC-Bl (6-711
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
NOTICE OF FILING OF APPRAISEMENT
HELEN CHADA
(Executor or Administrator)
In Re:Estate of MINNIE NAUSIDAS
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
j
___W_A_SH_I_N_GT_O_N__County -Fi Ie No.__6_3_-_69_......_;L_7_3 _
Dear rtJADJU1::
You are hereby notHjed that the O:.:;.R..:..:.I:.:;.G--=I:.:;.N:.:;.AL-=--_
appraisement in the estate of MINNIE N.\USIDAS
has been filed in the office of the Register of Wills of WASHINGTON
County on OCTOBER 15,,19....72..,Said appraisement reflects the following
valuations:
Real Estate 3-:-,0_0_0_._0_0 _
Personal Property _
T ransfers .,.--_
J oint Iy Owned __----,.,........,,=-=,...-_
Tota I 3"-,0_0_0 0_0 _
As to such tax that is paid within three months from date of death,a five (5%)
percent discount is allowable.As to any tax that remains unpaid a~ter nine (9)months
(fifteen months W1en death occurred from December 22,1965 to June 16,1971,inclusive;
and twelve months when death occurred prior to December 22,1965)from date of death,
interest at the rale of six (6%)percent per annum is charged.
Any party in interest who is aggrieved by an appr,aisement may appeal therefrom
as provided by larY,
DATE OF DEATH:JA!.\JUARY 6,1969
Note:This is nc,t a bi II.
ESTATE INSOLVEnT
t •
RCC-S9 (5-68)
,,,..,.:..~
(Initial)
Estate of NAUSIDAS,.MINNIE
(Last Name)(First Name)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX SUMMARY
==R=E=SI=D=EN=T=D=E=C=E=D=E=NT======::;:;:::::::::.:==========.==========:::!lL1:l===========
DATE OF DEATH_1-_6......9&-~~_FILE NO.63"!"69-173
REPORT OF INHERITANCE TAX APPRAISER
WASHHJGTONIttheundersigneddulyappointedInheritanceTaxAppraiserinandfortheCountyof _
Pennsylvania,do respectfully report that I have appraised the real and Ptlrsonal property as reported ia the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A","B","C",and "E".
Dated:OCTOBER 15,1973 FRED TOSI
INH ::RITANCE TAX APPRAISER
REGISTER OF WILLS
Dated:--:,O__C__T_1_6_1_97_3_RU_S_SE-LL-M_AR~
R~PORT OF TH~R~GIST~ROF WILLS !21~~~
I,the undersigned duly elected Register of Wills in and for WASHINGTON._l:t;'Pennsylvania,do respect-
fully report that I have allowed deductions in the amounts claimed by deponent,except a~tho items where a greater or
lesser amount is set forth in the,last column to the right in Schedule "F",which great~or lesser a unt represents t~e sum
allowed as a deduction.
VENT______--l...__
~:r fllY)nn
3,000.00
4,,030.51
ESTATE I 'SOL
VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
$$$-~-:-------+---
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
FOR USE OF REGISTER ONLY
Tax on $---------t---2%
Tax on $-----.-----t---®
Tax on $5%
Tax on $10%
Tax on $15%
D~pti~s *
Total Estate 1-.-_
TOTAL TAX
COMPUTATION OF TAX
$--....__------4--
$----------4--
$--...---------4--
$.......---------4--
$-..........------+---
$--1.__
(*)As evidenced by Charitable
Exemption Certificates issued
by the Se,cretary of Revenue.
Less tax previously paid
BALANCE
Less 5%of tax if paid within
3 months after death :::::::::::t=='
BALANCE OF INHERITANCE TAX DUE $~
Add interest a\~ate of 6%from $....JL
AMOUNT OF ESTATE TAX ASSESSED $.....,....jL-
Estate tax paid $_...._---....lL.-
BALANCE DUE $__-----1L-
Add interest at rate of 6%from
------ItIO-----TOTAL TAX BALANCE :========::~~
PAID $_------IL
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason,
same should be noted below,with short explanation.
Will l
Administration ~No......
IN THE
.Year ..
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
Late of .
County of
MJlNNIE.NAUSIDAS
Deceased
NEW EAGLE'
WASHING'rON.................
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Commonwealt~of Pe~nsylva,nia
REPORT AND APPRAISAL
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I OCTOBER 15 1973.COMMONWEALTH OF PENNSYLVANIA DATE .................................................1..................................................',DEPAP..TlI-U:1':T OF REVENUJE WASHINGTON
.'BUREAU OF COmiTY COLLECTIONS
RESIDENT INHERITANCE TAX COUNTY ....................................................................................................
HARRISBURG.PENNA.17127 APPRAISEMENT
FILE NO..........9.?..-=.Q.9~J,.7J.:!........................_.........................
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Whereas,MINNIE NAUSIDAS ·NEW EAGLE......................................................................................................................................................late of .............................................................................................................
in the County of ........................................:~A~~~.~~~9..~............................................................Commonwealth of Pennsylvania,having died on
the ..............................................................9.~h........................day of .........~.~g~~..............................................69 seized and possessed of an estate19............,
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore,I,FRED TOSI an appraiser duly appointed according to law,.......................................................~....................................................".........................,
having been designated to make a fair and conscionable appraisement of the said estate,and to assess and fix
the cash value of all annuities and life estates growing out of said estate,hereby file the following appraisement:
In the event that any future Interest In this estate Is transferred In possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future Interest.
Unit Appraisement
Description of Asset Values Made for Inheritance
Tax Purpoles
REAL ESTATE $
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SEE COpy OF APPRAISEMENT 3,,000.00 I
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RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
MINNIE NAUSIDAS
Deceased.
Late of
NEW EAGLE
Datc of Dcath,.....~~.~~y 6,1969.............................
Appraisement Docket Vol.......3.7-,.
Page,~.~~:?....................No 63-69-173.....
Filed in Register's Office,...9.g':r..~.l.:~.L:.19 7.~
Amount of tax due,$.
DEPARTMENT OF REVENUE
Received,
Examined and Approved,..
Wrote abo.llt Appra.isement,
Appeal /"0»1 Appraisement,.
Entered and charged,.
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