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C:\Documents and Settings\thomast\Local Settings\Temp\c.lotus ...

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_______________________________ ________________________________<br />

Address Personal Representative<br />

_______________________________ ________________________________<br />

City, State, Zip Code<br />

_______________________________ ________________________________<br />

Telephone Number<br />

________________________________________________________________<br />

FOR REGISTER OF WILLS USE<br />

Distributions subject to collateral _____ Tax thereon _____<br />

tax at _____%<br />

Distribution subject to collateral ______ Tax thereon ________<br />

tax at _____%<br />

Distribution subject to direct tax ______ Tax thereon ________<br />

at _____%<br />

Distribution subject to direct tax ______ Tax thereon ________<br />

Exempt distributions to ____________________ __________<br />

(Identity of the Recipient)<br />

Exempt distributions to ____________________ __________<br />

(Identity of the Recipient)<br />

Exempt distributions to _____________________ __________<br />

(Identity of the Recipient)<br />

Total Inheritance Tax due __________<br />

Total Inheritance Tax paid __________<br />

Gross estate __________ Probate Fee & Costs __________<br />

Collected __________<br />

-208-

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