4. Name and residence of the attorney of record of the administrator or executor,

5. Names and addresses of the special appraisers,

6. Date of the special appraisement,

7. Estimated value of the whole estate: Realty,

.....

Personalty, $..
Total, $...

8. The decree determining the inheritance taxes was rendered on the ............ day of............, 19...., and entered in the Probate Journal, Vol. ................................, at page

9. And the following is an abstract of the return made by the special appraisers, viz:

PROBATE INHERITANCE TAX RECORD.

[Form 560.]

PROBATE CAUSE NO. (Continued.)

Right Page

10. The following schedule shows the shares and proportions of the estate by the heirs at law (or, legatees) of said decedent, subject to inheritance taxes, the names of such beneficiaries, their relationships to decedent and their residences:

Names of heirs or legatees

Relationships

Residences

Share or legacy

11. The individual shares are classified in the following schedule, to show the nature and the total value of each share:

12. The following schedule shows the individual shares, the exemptions on such amounts inherited, the amounts remaining to be taxed, and the total taxes:

In the following schedule is the data respecting pay.

ments and receipts for taxes: