Land registry of Northern Ireland
Folios 12597 and 15032
Registered owner: Michael Jones
I, John Smith an officer of the Board of HMRC aged 21 years and upwards do solemnly and sincerely affirm and say as follows:
William Thomas who at the date of his death was the Registered Owner of the lands comprised in the above-mentioned Folios died on 5 July 1974.
His death gave rise to a charge for Estate Duty/Capital Transfer Tax/Inheritance Tax under the provisions of the Finance Act 1894/CTTA/IHTA 1984 as amended.
Michael Jones the above-named Registered Owner became entitled to the lands comprised in the above-named Folios by virtue of the Will of William Thomas deceased.
The Estate Duty/Capital transfer Tax/Inheritance Tax amounting to £3667.94 attributable to the property to which the said Michael Jones became entitled on the death of William Thomas remains unpaid.
I request the Registrar to enter a Charge for:
the unpaid duty/tax amounting to £3667.94 and
interest thereon at the statutory rate prescribed from time to time from its due date until the date on which the duty/tax is paid
as a burden on the said lands and I request that the Board of HMRC of Somerset House, Strand, London WC2R 1LB be registered as owner of the said Charge.
J Smith ________________ Affirmed at ___________________ _________________
This 6 day of June 1985 Before me ___________________ Solicitor