HomeMy WebLinkAboutOC1971-0503 - ESTATE OF TATE•
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FORM 67
REV. 1-50
REG. WILLS
J\ppliratinu fur 1E~tt~rn nf A~miuintratinu nu tqr
Estate of .................. Q.g.~.!.!:~.~ ... ~~~.!.~~~ ... ~~~~ .... ~ ............................. , ... : ...................................... : ....................................... ~·····~·······'··········· . . <:::
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late of.. ...................... B.ac.b.eY.Y.ille.-.. t'~l'f~rt'i~;:l ........................................................... , Deceased.
Before the Register of Wills of Washington County
personally a p pea re d .................................. BP..l:?.~.r:~ .... !.~~ .................................................... _. .. :·· .. ,: ..... : ........................................................ ..
~ho, being du~y sworn deposes and says tha:t ......................... Qh.~.rl~.~ ... W.~.l~9.~ .... ~~~~ .................................... : .............. ..
age ..... 9.§. ....... , having ..... ~J.~ ..... last family or principal residence at.. ....... ~~~~~J.!.~~-~~ ................... , .......................... ..
(Streetand Number)
.................................................................................. : ..................... ~.:: ................. ~, Washington· County, P~nnsylva~ia, died intestate
· (City. Borough. Township)
at. ................... .B:~.~.h~.Y.!~Jl~ ....................... , .................. , on the ... Jl.day of ........... f~.~~~-~Y. ................. ~ ............................... .
A. D.,·19 .... IL ...... , at... ......................................................... M., possessed of personal estate to the estimated value r . . ,
$ ...... .N.o.n.e. ................. , and~-of real estate in the Commonwealth-of Pennsylvania to the estimated .value of
~ . : .
$ ....... N9.~ .................. , situJ!;te in ....................................... :.' ..................... : ..... .' ................ ;_. ................................................................................... -...
c. ' ····················································t-..:·················································~······································································································································
The names and addresses of the decedent's surviving spouse (if ·any) and other heirs (including .. '
. heirs by adoption) are'-as follows.
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c. RELATIONSIDP RESIDENCE
······:·············································;;·················································· ........................................... !:::;·················································:········································
.... Rob.e.r.t .... T.a.t.e .............. ::~ .......... ~ .................................... ·:::.b.r.9.:t.b.e.r. .......... ·R:··-ql •... l, ... W.a.ynesbul!g.,. ... Pa ..................... : ....... .
..... Cur.t.i.S .... Ta.t.e .................. , .......... ~ .................................. t.brother ....... .-.: .R.~ .. ?F.-~ .. J ....... ~r.9:wD.~.Y.;tJ.le.., .... P.~ .... : ....................... .
.... Ed.ith .. :Tate ................................. : ...................................... sis.ter .............. R. .... D .•... l., .... Wayne.sbur.g.,. ... P.a •.... : ....................... ..
.... ~l.~:?i.~P.~.t..~ ... .P.J.9.~.in~.Qtl: ................. : ........................... ~.~-~t~.r .............. Hop:w.o.o.d., ... .Unio.nt.o:w.n., .... P.a ................................ ,.
······································································································· ···············.··················· ··································:····································································
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............................................... : .................. ~ .................................... :•''"''''''''''"'''''"''''''''' ......... :·.--~ ...................... ; ................................................................... .
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That deponent is over 21 years of age, resides at... ...... .R. .... D.: ... ~~ ... .W'ay.nesbu.r.g.,. ... Ea ................................. ..
..................................................................................................................................................................................................................................................
is a citizen of the United States and a resident of Pennsylvania, and respectfully applies for Letters of
Administration upon the Estate of said decedent,· no letters having been previously issued thereon .
Sworn and subscribed before me this ....... l.7 .... ; .......... .. . ~ ...... ~ ........................................... ~ ...
· May '-: 71 day of ............................................................ , A. D., 19 ...... : ......... ..
............... ~-~ ........
REGISTER
COMMONWEALTH OF PENNSYLVANIA } SS:
WASHINGTON COUNTY,
A~d now ............. M~Y .. J.7. ................................... , 19.It .... , come's ............... B:Q~.r.t-.~ .. !.!'1-.~.~ .................................................... ..
who being duly sworn doth depose and say that.. ..... he .......... : ...... will well and truly administer the goods and
chattels, rights and credits of... ............ : ......... Charle.s ... Wall.ac.e. ... Tate ................................................................ , deceased,·
to the best of.. .. his .... skill and judgment in striot compliance with the laws of this Commonwealth, mind-·
ful of the laws relating to inheritance taxes.
Sworn and subscribed before me this .... l1. .................. ..
day of... ................ ~~Y. ..... : ... : ..................... , A. D., 19.IL ........ . ~ ... ~ .................................................... .
·::::::::::::::::::::~:::~:::::::::::
REGISTER
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.... ~ Charles Wallace Tate .......................................................................................... : ............ .
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Letters .................................................... ..
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Extra Alias
Certificates
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Age 64
Occupation retired coal miner J
Estate of ... GA~.:r.l~ .. ~ ... Wall.~.C.~ .... 'r.a.te ................ .
Richeyville late of ............................................................... , Deceased
} No ................ of 19... .. ..
KNOW ALL MEN BY THESE PRESENTS,
That we, ~.().1>.l'l.r..~ ... ~t:l .. t.~ .... ~.~--.. ~-~-~!l:~.~-P.~.~ .... ~!lc:l ... ~~~~-~-c1 .... ~.~~~-~-~---·~·-~-c1.~.~.~~J .. ~ .. J?-.c1 ... G..~~.~8.nty Co. Baltimore, Md. Surety · ·· v
........... ; ............................................................................... , ....... ··························································································-··
all of Washington County, Pennsylvania, are held and firmly bound unto the Commonwealth of Pennsyl-
vania, for the use of those interested in the estate, in the_ sum of ....... F.'J.Y~ .. )1~p,q_r,_('l_g ............... Dollars,. to
be paid to the said Commonwealth, to which payment, well and truly to be made, we do bind ourselves,
joindy ahd severally, for ·and in the . whole; ·our heirs', . executors, administrators~ succ~sso-;s-and ;ssigns, and
each and every of them, firmly by these presents. Sealed with our seals and dated the . ~.'7.t.:tl.• ..... day of
........... , ..... ~~-~ ............................. A. D., one thousand nine hundred and ......... ~~-Y.€JP..~Y ... ~Il:~ ............ .
THE CO~DITION OF THIS OBLIGATION IS, That if the above bounden ....................... .
................................ Robe.r.t .... Ta.t.e ............................................................................................................................... .
Administrator or any of them, shall well and truly administer
the estate according to law, this obligation shall, be 'v'oid as to those who shall so administer the estate; but _,
otherwise, it shall remain in force.
Sealed and delivered in the presence of:
_,
~tntrmrut nf ~urrty
I, ------------------------------------------------------------------------· surety in the sum of $-----------on the
administration bond in the estate of _____ :_ ----------------·--·· say that I reside at
-__ ;, _____ , Washington Co.!!,nty, Pennsylvania; that I am the owner of real estate, the
title to which is in my own name and duly. recorded, sittfated in ................. : .................................................................................. ,
:~:pr~=y~ ::~:~: .. :o:d :!:: ~~ ~~::::~:::~~=~~~~~=ati _2'
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'-, Street ~-, · · P.O. ·'"'
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&.tntrmrutJ nf &urrty
I, ----------------------------------·--····-,~·---·---------.,~--------------------·-· -........................ , surety in the sum of $-------"'--------------·-----on the
administration bond in the estate of ..................... _________ . --------------------------------·-----------------------------·-----· say · that I reside at
--·--------------------------------------------------------------------------· Washington County, Pennsyl~ania; that I am the owner of real estate, the
title to which is in my own name and duly recorded, situated in .................................................................................................... ,
Washington County, Pennsylvania, worth above all encumbrances $ ..................... ___ : ____________________ ; and that I am worth the
amount expressed in said bond, over and above my just debts and liabilities.
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--------------------------
.Street P.O.
COMMONWEALTH OF PENNSYLVANIA, }
SS· WASHINGTON COUNTY, "' .
And now ...... ·.................................. 19 ............ , comes ....................................................................................................................................... .
who being duly sworn, says that he is acquainted with the financial standing of the securities to the within bond; that
the said obligors have each executed the said bond and that the sureties thereto are the owners of real -estate in their
own right of value more than the penal sum of said bond over and above all incumbrances and exemptions.
Sworn and subscribed before me this ------------------------
day of .............................................................................. -.... A.D. 19 ......... . -----------------------------------------------------------------------------------------
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A~mini.stratintt 1inttb .
IN THE ESTATE. OF
Charles Wallace Tate -------------------------------·------·-----------------------------------
·And now .. .M.ay ___ l7 ............. ~--------, 19 .'!.~----·
Bond approved and Letters issued . to
-------~---Bo.b~-~T.at.e ____ ~-----~'--------·-----
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0 . -___________ Rusa-eJ:~_;:.M.ar.1n~r _____ "':, _________________ _
o _ J:>· ::::C Register
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Bond Book ...... 6~-----------------Page ~-J_§~--
-~~~==============================
BADZIK PRINTING ~9 DONORA
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Form No. RCC-62 (6-70) THIS FORM REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER $10,000, UNDER SECTION 7n OF ACT OF JUNE 16, 1961, EF~ECTl:~ ~ANUA.RY !, 1962. (FILE IN DUPUCATE WITH\~OPY OF. Wll~-ATT~CH.EO) ~ ?,-I I -Ct>2t
OFFI.CE OF'1'HE REGISTER OF WILLS
County of .... -~v~~~~~~~.~~ .... , .... · ··
.... ~~P.~r:t .. r~.~~ ............................... of ,ij.,P.· .. II .. l, .. Way:neshurg,. P.a •... 1SJ70 .... .
(Name) ~ I .(AddreOII)
being duly --~F.5?~-~-------------------------.according to law, deposes and says that he is the _________ A,Q._WJ.'-•-------~----------,----------------------· . (Exec., Adm., Legaree, Etc.)
of the estate of .... Qh .. ~r .. l~§ ...... W .. ! ....... !' .. ~t-~ ........................................ ~ '"hose last residence was·----·-~-:!:~!?--~Y.Y..-!!J. .. ~ .. J1.5 .... 'J? .. ~-·-·---------··-·----· (No.) treetl
---------------------------------------------------·deceased, and that the whole of the estate of said decedent, who died -----~-':"J).0 .. -.-,-e7)_l _________ _ (City, Borough or Township) (
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA, WITH STATEMENT OF MORTGAGE ENCUMBRANCES UPON 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
Personal Property
.. Black Lu~g
NONE
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Estimated
Value
. NOTE: You.-may expedite the processing of this return by filing .. with it, 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 death, Such letters must be 8igned_ by a responsible· of~icer of the financial
institution or mortgage hulder and indicate clearly amounts of principal and interest in the decedent's
account at the date of death and the type of account, account number and the exact name or name·s in
X which the account is :registered,
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'•.• ''\ . .Jointly Held Propei·ty t:.
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Transfers within TWO YEARS Prior to Death
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NONE
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That at the time of death there was no safe deposit box registered ih dec-edent's individual name, or jointly wit~, 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 T.HIS SAFE OF.:POSIT. JJOX RENTF.:O I RELATIONSHIP OF' .JOINT
-IN WHICH DECEDENT RENTEO A SAFE DEPOSIT BOX IN NAME OR NAMES OF. i HOLDERS TO DECEDENT
NONE .. ----
-.. . --
BENEFICIARIES
. . ... . ( ..... , . .. . .
'FJ o C l · RELATIONSHIP SURVIVED AGE OF. LIFE
). •\. BENEFICIARIES AND ADDRESSES (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 OR NO AT .DEATH OF IN ESTATE
forth this fact.) DECEDENT
.. -. .
Robert Tate Brother ·-
... ~ . -..
R.D. # 1 : -.. -· l!faynesburg 2 Pao 15370
. -· . ---.. .
May Edith Tate Sister .. --
R.D. # 1
Waynesburg, --. --Pa. 15370
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, RESlDENT DECEDENT DEBTS AND DEDUCTIONS CLAIMED
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/~E: Li~fi~fiwi~msin~eQa~w-p-1-~-v7id7e~d~o7b-~-r-v_e_n_o_t-~~i-~-s-t~~-·~-~-o-n-a-n7d~i-n-~-r-u-ct~i-~-s-----------------
~ . ----· .
DEBT OR CLAIM NATURE OF SAME AMOUNT THIS COLUMN -. ... . . .. ' .. ~EGISTER ONLY
Greenlee Runeral Home Funeral expenses paid $ 507 oc $
I Family exemption {will not be allowed unless I
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decedent died residing with a spouse or children.) I
I 20 00 .
Administration Expenses •
! Counsel fees ~ I
Fiduciary cbmmission '"
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OTHER DEBTS AND CLAIMS
I ('") See Note below
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Taylpr Cemetery Ass. Openeng & Closing of Grave 75 00
·--· -" '· .. ~ ·-I I Fi:r~t Christian .Church Funeral Services I 20 00 . ' ''j -. .. ~
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Jefferson Flower Shop -; Flowers 20 00 .... ~ ! C" I
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Total 642 jOO l '1'1., ~0
Note: The estate agrees to advise thl.! Register of Wills ifthc amount actually paid in settlement of any fee, commission or· d!ebt is greater
or less than the estimated amount claimed and allowed.
. .... dH:h.~ ........ · ............. .
( fJxecutor··Administrator) ·
(Street Number)
(City or Town and State)
In the event that any future inte1·est in this· estate is transferred in possession or enjoyment to collate·i·al heir·sr of the decedent after the
expit·ation of any estate for life or for years, the Commonwealth hereby express!y··r·eserves-the right to appraise and assess transfer·inheri-
• ( <"'-( ' • tance taxes at the lawful collateral rate on any such future interest. '1 ·
· .• · 1 REPORT OF T~;BTERfPf WILL~ f ·
1, the undenigned duly elected Register of Wills in and for... . . . . ~.~ .. County, fennsylvania, do respectfully
:c<:portihllot I h::J.ve allowed debts and ~eduction~ in the amounts clat. y deponent, exc~~items wh<:re a _greater or lesser ~mount
a;; set iorth m the last column to the nght m satd ·schedule above, whtch greater or lesser amo-rt repi'es~'l!ts the, ~u_m allowed as a deductr.on.
Dated: .... l.~.-~ .. ~~-·l.\.1.~.......... . ............ ~ ... (.l .... w.~~-~ .. ' . t ·' · ~ .~Regi~r of W11ls
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Form No. RCC-62 (6-70) t·-:1-71-6'7J'.:.3
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" '--1 ,:~ Will-l ~ Administ:tation sNo. · ......... Year .... .
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IN THE C)
0. MAT'F.ER OF THE APPRAISEMENT .:: ·_,.-i
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.) ESTATE OF (· -~ ~
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:Charles W. Tate ....................... ·.·. ·n~~~s~-...
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Q =~ t~ Richeyville ·.:: Late of
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Co~hty of ... :. Washington
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"'' ~~ Coi#monwealth of Pennsylvania
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0 REPORT AND APPRAISAL
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·. Personal Property
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Joint . Accounts .·
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Less ·Exemptions .· '
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·.TAXABLE AMOUNT·. . . .......... _ ........................ ~ ................. -.... . . .. .. . · ...
TAX ~n-~ .. : ............ ~.-........ : .. @~---% ---. -.. --· , · · ·.· · .. ·· · · · . · ·
.. TAX od.J...L.· ·9. .. 9 ........ :~.@ .. ·/s--~-~---~~~~ ... ~.~?.~L ...................... : ....... _ ... : ....... ~ ..... : ... ~ .......... ~ ....... J...L ... ~.£ ...... ·.
· Amount Previously Paid . . . .......................... ~ ..... ~ ....... ~ ................. ..
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TAX BALANCE . . . -·······~ ............................................ -..... .
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Interest from ....................... L._.:::._z" ____ to ... -...................................................... -..................... .. . .
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WASHINGTON; PENNSYLVANIA a~.
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RCC·81 (6·73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
NOTICE OF FILING OF APPRAISEMENT
ROBERT TATE
(Executor or Administrator)
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
In Re: Estate of __ C_HARIE_---,-s_· ·_w~ALLA __ GE __ TA_TE ________ _:__ __ _
WASHINGTON! C , F I · 63-71-503! ounty - i e No._·---------~
Dear Mr. Tate:
·original You ore here by notified tho t the --7"1"'1:'=..--=-:=-.-:r=-rr:::-::-::::--n=:-:--------Cha:rles Wallace '1'ate . appraisement in the estate of _______________________ _
has been filed in the office of the Register of Wi lis of _ ___,Wwa,.,s....,bu...j ... n~gt,....,.o .... nL.._ ______ _
County on August 14, , 19___:&, Said appraisement reflects the following
valuations: ' ·
Real Estate --------;:u;;;--;;-.~------
Persono I P roperty ___ 87_..:...::5---"''-0_0 _____ _
Transfers _______________ _
Jointly Owned ----,-------------
T ota I --·--------'87 ......... 5L.Ce._,.·O""'O----'-----
As to such tax that is paid within three months from date of death, o five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine {9) months
(fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from dote oii death,
interest at !he rote of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Date A1lg)!st J,i,, 1974 S;gne~
Title Appraiser 11
~·.1~ . C/'
DATE OF DEATH: February 11, ].971
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Note: This is not o bill.
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RCC·39 ,~~~8)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
f TA'IE, CHARlES WALLACE 2-i1-71 63-71-503 Estate o ----------------------DATE OF DEATH ______ FILE NO. _____ _
(Last Name) (First Name) (Initial)
REPORT OF INHERITANCE TAX APPRAISER
WASHINGTON I, the undersigned duly appointed Inheritance T~x Appraiser in and for the County of_-:-------------
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in 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: . Au~st 14, 1974
REPORT OP THE REGISTER OP WILLS 'I k ~ , ~
I .h · d · d d l . 1 d R · · · \".'1 · d f . Washington c p 1 · d , t e un ers1gne u y e ecte eg1ster ot ·•tt s m an or . ounty, ennsy vama, o respect-
fully report that I _hav·e allowed deductions in the amounts .claimed by deponent, excep~ to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which~ate~or lesser amount represents the sum
allowed as a deduction. .
1 I -!~ -. ( . f '
Dated: \ \.J a......~ . ( 9 1 f./ \ ~ . ~
~ .'REI:>ISTER OF WILLS
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
annuities .• ................ · ..
ESTATE TAX ASSESSMEN.TS
FOR USE OF REGISTER ONLY
Tax on·$
Tax on$ 2335~ 00
Tax on'$
Tax on$
Tax ·on$
Exemptions
Total Estate
TOTAL TAX
Le.ss tax previously paid
BALANCE
Less 5% of tax if paid within
3 months afte~. death
VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
$ $--~-~-~"~--875.00 $---------~--
$
$
2%. <§)-
5%
10%
15%
*
$
$
·$
875~00
6L2 00
I. ·.,
______ ...J._ __ ~ •.
COMPUTATION OF TAX , <:-. _,_
$ ------;,.".;.,' -+.,....,.....!t:.... • . • ·. -~ ------'3=4=··~95::......:....;· Paid in full R~cei'pt u· D 33641 $·'
$
$
$
$
r •
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of ~evenue ...
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
$----------4----
-----to -----$---------~---
AMOUNT OF ESTATE TAX ASSESSED $-----+--
Est~te tax paid $ _____ __....;...__
BALANCE DUE
Add interest at rate of 6% from
-----~·0-----
$--------~---
$------4---
TOTAL TAX BALANCE $ ------+---
PAID $-----~--
FOR USE OF REGISTER ONLY ADJUSi.'MENTS
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.
.,
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Will
Administration t No. > .......... : ...... Year
IN THE
MATTER OF THE APPRAISEMF;:NT
Late of.
7
OFT.HE
ESTATE OF
·~ '.• CHARLES WALLACK TATE
· · · · · · .. ·~· ~ ·:; · ~ ::, .. ·-·~~·:,·:.: ·~·:.: ·_ · · · · · · ri~~~~sed
RICHEYVILLE: .. .', ... · ... ··: ... :;··-~: .......... · .. .
~-,, ,... .... : :~; ~;-. ...
County of . WASHINGTON
Commonwealth of Pennsylvania
REPORT AND .APPRAISAL
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RCC-2 (2-64)
DEPARTMENT OF REVENUE
BUREAU. OF COUNTY COLLECTIONS ... ~_·
HARRISBURG, PENNA, 17127
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COMMONWEALTH .OF. PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE August 1.42 1974
COUNTY ~~:~A~#~r.~G_TO~N~-----
FILE NO; 63-71-503
Whereas, __________ C_H_MITE ___ s __ W_AUA ___ c_E_· T_A_TE __________ lateof ____ R_I_CHE __ Y_V_I_UE ______________ _
in the County of vlASHINGTON Commonwealth of Pennsylvania, having died on
the 11th day of February 19 71 , seized and possessed of an estate
subject to Inheritance Tax under t~e ~aws of the Commonwealth of Pennsylvania; Irolilln~c R. DeMaria Therefore, I, 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.
PERSONAL:
See copy of appraisement
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Description of Asset Unit
Values
$
Appraisement
Made for Inheritance
Tax Purpose&
875. 00
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Having been duly sworn accordi118:Jp law, I do hereby certify that the above apprai~ement is made in con-
formity with law on this t f ~ day of ,...... Cl..-<__,._.-J.. ::r-19~. \ \f)->-nJl ~ NL v )..~,..A . .
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WASHINGTON C Oltllty
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate o{
CHARLES WALLACE TATE .. .----
· Deceased. ·'
.Late of
RICHEYVILlE
Date of Dea;i;: -· 'FEBRUARY 11, 1971
Appraisement Dockel-v~z:;·.---...:? /i'
Page, / 7 t,L-t./ No. 63-.71 -5Q3·
Filed in Register's Office, August 14, 19 74
Am.ount of tax due, $ --.
DEPARTMENT:OFREVENUE
Rereived, .. ·----------------
• Examined qnd Approved,_ -----___,....,._ __ _
Wrote ;tibo.ut Appraisement,
Appearj,om Appraisement, ....,..._....__ ____ ._
Entered and charged_, ____ _... _ _,_ ........ __
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