TENNESSEE DEPARTMENT OF REVENUE
Schedule C  INHERITANCE TAX RETURN SCHEDULE
INH         CASH, NOTES, MORTGAGES
301
ESTATE OF               DECEDENT'S SOCIAL SECURITY NUMBER

Item        Description                    Accrued                                                                                               Value at
Number                            Interest, ETC.                                                                                                 Date of Death

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

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

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

RV-F1400301                                                                                                                                      INTERNET (1-98)