AF00169548 Deceased estate Mary Ellen Cazalar NRS-13340-1-[20-5118]-B 53874 - Flipbook - Page 7
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01,
REQUISITION
Qi,
For Payment of Duty in
states
of Deceased Persons.
Payment made by(1) "..
of c2)
ce
6.6 d•
L.A6
444,6
164 6 64666
/QV
(1)Christian and Surname in full.
..... 44.6•646,4664.446444646444
••••• •
444666•4664.6446664.64446.66.6.4644.64,446461
••• .......
NW 1
•••••• •• •
(2)Plac• of Busi ss, or Residence, and Post Town.
limoommoomme,
No.
538.7
•
44.444.4
Name of deceased
/OR
Late address
Date of death
eiZi4fig
'54-41)(--04
Cif •
••••••••••••••
/..r*
s.
Assessment Notice No
Death ty pay
Laterent on amount of duty from
days at
0/0
d.
JOB
/411f'
to
• •
• • •
• • •
•• •
)
6-0
AL
'
tit'iTraiii
A12624,-.:4 -
Signature of person paying the duty
Date
T. H. TENNANT, GOVERNMENT PRINTER.
•••••••••••••
