HomeMy WebLinkAbout12-05-78
.
R C C-38 ~4-7 31
COMM~WEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
dJ-' 7Y- 'ftJO
..
RESIDENT DECEDENT
nl:r ", c.;.
'-'I..'~ U V 1913
COUNTY OF CUMBERLAND
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date or death, unless an extension is granted
by the Secretary of Re'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF 1 AFFIDAVIT OF
LAWRENCE LEVI HAMACHER A/K/A LAWRENCE
LEur HA~l\(,HE'R ~ IT{ I~ T.~W'R~Ni'F. T. H~MM' IElXECUTOR
STATE FULL'NAME OF DECEDENT)
~~X1fQk
Lola of CUMBERLAND Counly
Slale of
PENNSYLVANIA
CUMBERLAND
} 55:
Counly of
Lawrence Levi Hamacher, Jr.
XIElKMHiliJ6K
& James A. Hamacher
Executor S
of the estate of the above-named decedent being duly sworn, depose and say
Julv 10, , 19~{~0'lalo leaving a 1001 will, copy of which io horolo altachOd..}
(MONTH) (DAY) (YEAR) I~~X
Namo and oddro.. of attarnoy or} 'Rnhprr T. Myers. III, Myers. Myers r Flower &
other authorized representative to whom . 3
P 0 Box 125 Lemoyne Pennsylvan~a 1704
all carroof'ondonco ohauld b. mail.d. .. I I
Decedent died
Johnson
That as such Executors deponent is familiar with the affairs of said estate and the property constituting
(EXECUTa R-ADMINIST RA TOR)
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in 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 $.-\FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDEN T
None
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception' of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furnitur~,hbrses-, carriages,
.." . '." j
automobiles, boats, and any and all other personal chattels of whatsoever. kindoc"llature, left bfd~'ecient,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and. or' all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair.market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interes t thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the market value there-
of at such time,
/
.
.
In the case o~ securities o~ close or ~amily corparations, the values reported are as ~ar as
possible substantiated by ~inancial statements o~ the corporations, showing the assets and liabilities
thereo~ as o~ the date o~ death. The schedule also sets ~orth the interest o~ decedent at the time o~
death in any co-partnership or business, and in support o~ the value o~ such interest there is annexed to
said schedule, ~inancial statements showing the assets and liabilities o~ said co-partnership or husiness.
A copy of the co-partnership agreement, (i~ oral, a statement setting ~orth the nature of tne agreement)
together with a statement setting ~orth the character of the business, its location, and such other'~acts
pertaining to the business as may be pertinent to a ~air and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized ~orm, together with the ~air market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereo~ sets ~orth a true answer to each inquiry
contained therein and in the case o~ trans~ers of property, real or personal, within two years o~ decedent's
death, in contemplation o~ decedent's death, or intended to take ef~ect in possession or enjoyment at or
a~ter death, said schedule sets ~orth the nature and value of such property, to whom transferred, the
relationship o~ the trans~erees to the decedent, the proportionate share received by. each trans~eree and
all other ~acts o~ a pertinent nature regarding said transfers. In the case o~ trans~ers intended to
take e~fect in possession or enjoyment at or a~ter death, there is also attached to the schedule a CORY
of the deed, trust agreement or other instrument creating the trust. Ther~ is also set ~orth in said
schedule a list o~ all property, real and personal, with its value, which passes at decedent's death by
virtue o~ the exercise by decedent, either indiVidually, or jointly with another, or any power o~ appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrwnent o~ another,
with a copy o~ the instrlunent creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets ~orth the names and addresses o~ all
persons bene~icIally interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, i~ any, to the decedent, together with the ages at the time o~
decedent's death o~ all minors, annuitants and bene~iciaries ~or life under decedent's Will. It also
contains a statement showing which o~ the beneficiaries named in the decedent's will, i~ any, died prior
to decedent, the dates of their death, their issue, and the relatIonship o~ such issue to the bene~iciary.
That Schedule E attached hereto and made a part hereo~ sets ~orth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
o~ the decedent and others, plus the date and place o~ record o~ instrwnents e~~ecting the vestiture of
real estate and the date o~ acquisition o~ personalty, plus the name, address and relationship, i~ any,
o~ co-owners to the decedent.
That Schedule F attached hereto and made a part hereo~ sets forth fUlly and in detail all debts
and deductions claimed ~or and on behal~ o~ this decedent's estate, including fUneral expenses paid;
~amily exemption, where applicable; costs o~ administration of this estate; counsel fees and fUdiciary's
commissions paid or to be paid; cost expended ~or burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence o~ the death of the decedent; debts and claims owing and unpaid at time of
death; taxes accrued chargeable ~or period prior to decedent's death (except those allowed under Section
651 o~ the Inheritance and Estate Tax Act); together with a statement of collateral pledged ~or obliga-
tions, if any. It is agreed that the ~iduciary will present proof o~ said claimed obligations upon re-
quest, that i~ the amount actually paid in settlement o~ any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register o~ WillS, and that
the amount o~ tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "CO, "E", and "F" as directed therein,
have been carried ~orward and properly registered in the Summary.
Subscribed and sworn to before me this .................................
awrence eV1 Hamacher, Jr.
......................;?.~...~.. ...... day of ....~.............. 19....1..J.. ........~.~.~.....~~.~.:.:.:.....~.~...~...~......~.:~.~.~.~.~.~.~.~:.2!.{ 7~~!
__D~....... ..~.... ................--- ~;;;;;;SA~-~
NOTARY PUB~ ""
My CoIllllUI.liOl1 Expirel Dec. 21, 1981 .J.4..3.~.....;e.r.!..g.gg.....~.:t......t......N.gw.....<;w.nP..~r..J..9.'p':.d, Pc
r_c:n~yna. Pa. Cumberland Cou" (City or Town and Sf4te) 17070
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
,0'. .~ '. "~'.'.
~c-u (40)13)
COMMotolWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
'RESID!NT DEC:I!D~N'T
SCHEDULE HAu
REAL PROPERTY
*'
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant jn common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
Th. r.al property locoted In the Commoll_alth of Pellll.yl"anla .hould b.
d.scrlbed by lot alld block numb.r. str..t alld .tr..f lI11mb.r, tog.th.r with
a g.lI.ral d.scrlptlon of the prop.rty. with a r.f.r.llc. to the r.cord of the
cOllveyallc. by which th. d.e.d.llt took tltl.; If a farm .tat. numb.r of a.
cr..; 01.0 .tat.m.llt of mortgage .lIeumbrallee. UpOIl .aeh pare.1 at d.ath
of d.e.d.llt. Taxe.. a.....m.II... aeeru.d IlIt.r..t 011 mortgag.., .te.,ar.
to b. II.t.d 011 Sc:h.dlll. "F" alld mu.t 1I0t b. d..duet.d from thl. .eh.dul..
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do net wrl"
In thl. spae.)
ASSESSED VALUE
FOR YEAR OP
DECEDENT'S
DEATH
ESTIMATED
MARKET VALUE
Real Estate - known as #739 Bosler
Avenue, in the Borough of Lemoyne,
Cumberland County, Pennsylvania, in the
name of the decedent and Margaret L.
Hamacher, his wife (Margaret L. Hamacher
died December 7, 1965) by deed dated
March 27, 1947 and recorded in Deed Book
M, Volume 13, Page 163.
Sale price to Bruce E. Shelly
35,noo.oo~~,ooo.oo
I., ~ '-l 0
___ 'I
Jol.} 9 " (;
)
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
.35,000. 00
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time or his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name or the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the ract that they are not or the administered estate.
Tangible personal property should be listed rirst (e.g. jewelry, wearing apparel, household
goods, and rllrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certiricates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or riduciary in said capacity, partnership interests, interest in any undistributed
estate or or income rrom any property held in trust under the will or agreement or another, even though
located outside or the State, at the time or death, should be listed in this schedule.
Item
No.
ITEM
List and describe rully
UNIT
VALUE
ESTIMATED
MARKE:r VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1. Dauphin Deposit Bank & Trust Company
Checking Account No. 40-39-298-8
Date of death balance
Certificate of Deposit No. 5045
Date of death balance, plus interest
3. 1968 Cadillac
6,415.93 A It'S.Q3
10,020.26/' lO, 0 aD. ~t.
1,652.88/ IJ"!f~."
300.00/ '00.00
2. Household Goods - Sold
4. Carpenter's Union - death benefit
~ayable to Estate
5. Medicare reimbursement
600.00'
320.00/
~OO. 00
~)..o. 00
6.
Real Estate tax adjustments
at settlement of 739 Bosler Avenue,
Lemoyne to Bruce E. Shelly
/
269.2rl
0\ ~'t. ~
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page or this return.
x X
19,578.27
lit 5'1'S, ~,
)
RCC-%
CllMMll:\WEi\LTIl OF PENNSYLVANI i\
TRANSFER I:\HFH.ITA:-iCF TAX
SCHEDULE "c"
Tfu\\lSl'l<;llS
I\ESIDEXT Dl,CEDEXT
(1) Did decedent, within two year.. of death, make any transfer of' any material part of' his estate, wIthout
receiving a valuable and adequate consideratIon therefor? (Answer yes or no) NO
(2) Did decedent, wi thin two years of rleath, transf'er property f'rom himself' to himself' and another or
others (including a spouse) in joint owner..hip? (Answer yes or no) No
(3) If' the answer to (1) or (2) above is in the affirmative state:
(a) Age of' decedent at time of transfer
(b) State of' decedent's heal th at time of making the tran..fer. (Note 1).
(c) Cause of' decedent's death. (Note 1).
(4) DId decedent, in his lIfetIme, make any transf'er of' property wIthout receivIng a valuable or adequate
consideration therefor whIch was to take ef'f'ect in possession or enjoyment at or after his death?
(Answer yes or no) No
(a) Was there any possibi 11 ty that the property transferred might return to transferer or his
estate or he subject to hIs power of disposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lit'etime make any transfer without receiving a valuable and adequate consideration
therefor ,mder which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before hi.. death:
(a) The possession or eT!joyment of' or the right to income from the property transferred?
(,\nswer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserverl power to alter, amend, or revoke, or which c01l1d revert to rlecedent under terms
of transf'er or by operation of law? (Answer yes or no) No
(9) If' the answer to (8) above 13 in the affirmative, was the power to alter, amend, or revoke the inter-
est of' the beneficiary reserverl In the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The anSwers to these questions should be supporterl. by affidavit by the attending physician as
well as a copy of the death certif'icate.
NOTE 2: If anSwer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to .'hom transferrerl, with
relationship of transferees to decerlent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on Which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Estimated)
DEPT. VALUATION
(Dept. Only)
NONE
N 0 r"\L
Insert this total opposite "Transfers", Schedule "CO in the
"As Reported" column on the last page of this return.
M,tlf\.l.
RCC-37- (12-63).
CO\IMO"'WEALTII OF PE;I;;I;SYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
a,e an interest, vested, contingent or other are involved, set STATE YES IN ESTATE
wise in estate) forth this fact.) OR NO BIRTH
Lawrence L. Hamacher, Jr. Son Yes Adult One-half residue
Q, ? "....._~....r
Mechanicsbura, Pa. 17055
James A. Hamacher Son Yes Adult One-half residue
, .d 'HI Ryo; no.,. .r
1\1""01 -. .yo' :'Inn P:'I '7n7n
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
Will
Administration
~ No.
(Executor-Administrator
must complete "As
Reported" column #1.)
Year ..........
rn THE
C"l
...
o
'"
'"
~IATTER OF THE APPRAISEMENT
'"'l
e;
III
<:T
;-
OF THE
ESTATE OF
tr1
'"
...
III
...
(1l
LAWRENCE LEVI HAMACHER, etc.
Deceased
Late of ... Boroughof..LemOyne
County of
Cumberland
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
..., 0-0 ~
.., ~ Cb
~ : ~
'" 0
tb' ::l 0-0
"'1 e. ..,
'" 0
0-016
... ...
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(1l
...
...
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(J)
c:
~
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....... ~
W(J)W-<
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""""""~"""""""""
Myers, Myers, Flower & Johnson
P. O. Box 125
Lemoyne, Pennsylvania 17043
: f-' :w .......
: \0 :\.11 a:-
. :...,....
: I ;\.11;0 ~
. . . ('t)-
: 0 , -.J :0 -0 .....
: I . CXl :0 0 ~
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: '" :0 (t
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~ RCC-3B
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEAL TH 0 F PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
with another or others, including intangibles, standing in the name of' the decedent and others. List
real estate f'irst, as entireties, or joint tenants, giving brief' description, as indicated under Schedule
"A", plus the date and place of' record of' instrument ef'f'ecting vestiture, but do not include entireties
or out of' state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of' acquisition, and the name, address and relationship (if' any) of' co-owners to
the decedent.
.
Description of' Property, Date of' Acquisition, Name Unit percentage Estate DEPARTMENT VALUATION
Address and Relationship of' Co-Owners, and Place Value Share Valuation CAUTION-Do not Write
of' Record of Instrument, where Real Estate. In This Space.
:, ?SX V x: >> :.> VVV' Value of' Value of'
:, V 'V' v
:.> v En ti re Decedent's
~ ~ "v
YV' I'.., Property Interest
v I'..,
t\l oN...
NONE
Insert this total opposite "Jointly Owned Property", Schedule "E" NONE
in the "As Reported" column on the last page of' this return.
..
REV.SIB (B-nl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Divis ion
lolOTJCE OF FILING OF A~PRAISEMENT
Lawrence L. Hamacher. Jr. JamelS A. lI8macher
912 Robert St. 1438 Bridge Street
Mechanicsburg. PI. 17055 New Cumberland. PI. 17070
(Executor or Administrator)
In Re: Estate of
Lawrence Levi Hamacher a/k/a Lawrance Levi Hamacher
a/k/ a Lawrance L. Hamacher
Cumberland
County - File No.
21-78-0400
Dear Mr. Hamacher:
You are hereby notified that the or~ll:inal
appraisement in the estate of~Lawrence LeV:1. Hamacher
has been fi led in the office of the Register of Wi lis of Cumberland
County on January 19 , 19 79, Said appraisement reflects the following
valuations:
Real Estate
Personal Praperty
Transfers
Jointly Owned
Total
35.000.00
19.578.27
None
None
154.578.27
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 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 date of death,
interest at the rate 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.:.~~73. ,_, l
Date January 19. 1979 Signed ~ \. \,J-../~'::.)~ .-~~
Title Administrative Officer
Note: This is not a bi II.
RC C-2 (2-64)
DEPARTMENT O~ REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
January 19. 1979
COUNTY
Cumberland
FILE NO.
21-78-0400
VI.
late of
Borough of LemoJIDe
in the County of Commonwealth of Pennsylvania, having died on
the lOth day of July 19 78 , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulll:ini ti . 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 deeedent 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 Auet ValulI Made for Inheritance
Tn Purpoles
Real Proper tv $ 35.000 00
Personal Property 19.578 27
Joint-Held Property None
Transfers None
TOTAL ASSETS 54.578 27
~avi~g been duly ~worn accordinf to law, I do hereby cer~ify that the above appraisement is made in con-
forrmty WIth law on thIS 19t day of '-.5), ,- -:~ Q.~ 1922-.
c~7Q.:u \:: \_Jv.c_/
Q Approi...
(Il\Jmber IU\4 St....t) b
ttarrI.S urg
(Paot 0ftI..1
, Penna.
;( t -'] ~, ~ 00
Cumberland
County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
IAWRENCE IEVI HAMACHER a/k/a IAWBANCE
UlVI HAMACHER a/k/ a IAWRANCE L. HAMACHER
Deceased.
Late of
Borou~ of Lemqyne
Date of Death, July 10, 1978
Appraisement Docket Vol., 10 6%
Page, I ?b No. t,
Filed in Register's Office,
Anwunt of tax dlle, $
1/19/192!L
DEPARTMENT OF REVENUE
Received,
Examined and Approved,
Wrote abo.ut Appraisement,
Appeal j,.om Appraisement,
Entered and charged,