TENNESSEE DEPARTMENT OF REVENUE
Schedule K  INHERITANCE TAX RETURN SCHEDULE
INH         DEBTS AND MORTGAGES
301
ESTATE OF   DECEDENT'S SOCIAL SECURITY NUMBER

Item
Number      Name of Creditor and Address with Description Nature of Claim                                                                            Amount

1. Total ............................................................................................................................................

2. Total (From any attached sheets) ................................................................................................

3. Total (Add Lines 1 & 2, enter here and also on Page 3, Line 12-K) .............................................

RV-F1401101                                                                                                                                          INTERNET (1-98)