TRANSFER TAX ACT, 1971

REVENUE AFFIDAVIT
DISPOSAL AT DEATH
(For use where Deceased Died AFTER 31st May, 1974, AND a DISPOSAL of all property, PERSONAL and Real
are Deemed to take place).
Name(s) and Address(es) of person(s) to whom communication to be sent.

.R. a.m. o. n. .C.la.y.to. n.,.A. t.to.r.ne.

y. -.at.-.L.aw. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.5.6. B. a.l.m.o.ra. l.A. v. e.n.u.e,. K. .in.g.st.o.n. 6.,.S.t.. A. .nd. r.e.w., .Ja. m. .ai.c.a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

In the Estate of .P.e.te.r.P.a.n.e...........................................................................................................................................Deceased

I*, . M. .ar.y. S. p. r.a.t o. f. 2. 2. .L.ak. e. D. .ri.v.e,. V. .ox. x. .H.a.ll. M. .an. o. r., .O.c.h.o .R.io. s. P. o. s.t.O. f.fi.c.e,. S. t.. .A.n.n.,
J. a.m. a. i.ca. . . . . . . . . . . . . . . . . . . . . . . . . . . .

............................................................................................
............................................................................................

make oath and say as follows :-

.S.u.rv. i.n.g .e.xe. c.u.tr.ix .............................................................................................................am/are trustees of a Settlement

desire to obtain a grant of .P.r.ob. a. t.e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

of the above named. P. e.t.er. P. a.n.e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.
2 2 L a k e D r iv e , V o x x H a l l M a n o r, O
.L. a.te. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ofSt.. Ann,
. . .Jamaica
. . . .. . . . . . . . . .. .. . . . . .
c h o R i o s P o st O ffice,
. . . . . .. . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . deceased who died on the .1. . . . .day of .Ja. n. u.a.ry. . . . . . . .

One/Two Thousand. a. n.d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hundred and. t.w. e.n.ty. -.tw. .o . . . . . . . . . . . . . . . . . .

...

aged.6.7. . . . . . . . . . . . . at. 2. 2. .L.ak. e. .D.ri.v.e,. V. .o.xx. .H.a.ll. M. .an. o. r., .O.c.h.o.R.i.os. .P.os.t.O. f.fi.c.e,. S. t.. .A.n.n.,
.Ja.m. a. i.ca. 1. . . . . . . . . . . . . . . . . .
Jamaica on certificate of title registered in his name as a sole proprietor
domiciled in. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

that part of Jamaica called. S. t.. .A.n.n. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

............................................................................................
AS AT THE DATE OF THE DECEASED'S DEATH, so far as I/we have been able to ascertain, the gross value of all the
property subject to the disposal on death amounts to $. . . . . . . . . . 5. 5.,0. 0 0.,0. 0. 0.
The aggregate amount of mortgage or other incumbrance on such property amounts to $..............................0. and
reduces such value to $. . . . . . . . . . . . . . . . .0. .

To the best of my/our knowledege and belief there is no other property, real or personal under any title whatsoever
beyond that already referred to, in respect of which Transfer Tax, Estate Duty or Sucession Duty is payable on the
death of the deceased.□
□
All which is true to the best of my/our knowledge and belief.

.M. a. r.y.S.p.ra. t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
INSTRUCTIONS:
*Insert here the name, address and description of each person who joins in the Affidavit or Affirmation.
**Insert here "Probate of the Will", or "Administration with the Will annexed of the estate", or "Administration of the
estate", as the case may be.
Please TYPE or PRINT. Use BLACK or BLUE INK only.

NOTES
1. Where it is claimed that the Deceased was domiciled abroad at the time of his/her death, insert here the name of the
Foreign Country, State or Province, as the case may be, in which he/she is considered to have then been domiciled, and
strike out the rest of the paragraph. The circumstances relied upon to establish the foreign domicile should be stated in a
schedule to be annexed hereto. The domicile of origin should always be given.
2. If the Deceased was more than once married, annex a statement showing the name of the surviving husband or wife, and
the names of the children of the several marriages, distinguishing/differentiating them.
SWORN by the abovenamed

.M. .a.ry. .S.p. r.a.t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...........................................................

22 Lake Drive, Voxx Hall Manor, Ocho Rios Post

at .O. f.f.ic. e....................................................................in the Parish of

S. t...A. .n.n. . . . . . . . . . . . . . . . . . . . . . . . . . .this. . . . . . .2.8 . day of

D. .e.c.e.m. b. e. r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.2.2. . . . Before me.

 PART
PERSONAL PROPERTY AND REAL PROPERTY
SUBJECT TO DISPOSAL
Stock or Funds of Jamaica viz Nominal Market Price at Gross Principal
Value date of death Value□□□□
N/A

Stock, Funds, or Bonds of foreign Companies

N/A

Shares, Debentures of Companies

N/A

Options

Leases
N/A

Settled/Joint-Realty (Full particulars to be attached)

N/A

Realty (The Description and situation of the Property should be such as to enable it and its
boundaries to be clearly identified).
N/A
 PART

AN ACCOUNT OF INCUMBRANCES UPO N DISPOSAL SHOWN IN PART 1

Nature of Debt N/A
or incumberance
and by whom
created

An account of the Funeral Expenses of the Deceased

The cost of N/A
Tombstone
cannot be
deducted

OBSERVATIONS ANSWERS
Was the Deceased interested in any Policy of Life
Assurance whereby any sum is payable to a Mortgagee
consequent on his Death?□
□
If so, please give full particulars thereof. Did the
deceased carry any form of Mortgage Insurance?□
If so, please give full particulars thereof

SUMMARY OF AFFIDAVIT

Gross value of Property shown on Part 1 $ 55,000,000

Deduct Debts and Funeral Expenses $ 1,000,000

Net Taxable Value $ 13,750,000

Duty Payable $ 1,100,000

N.B. - Interest at the Rate of Six percent (6%) per annum shall be paid upon any of Tax outstanding from and after
the expiration of Twelve Months of the Date of Death of the Deceased to the Date of Payment.