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)