Aff - Blackard, Sam_10/5/1978.-� �
�7
STATE OF INDZANA )
)SS:
LAWRrNCE COUNTY )
�
ETHEL ADAMSON being first duly sworn says that she is
a daughter of Samuel (Sam) Blackard and Nellie Blackard, both of
whom are deceased; that the said Samuel Blackard died on or
about November 21, 1964, intestate, leaving the following persons
as his heirs at law: Nellie Blackard, his widow, Ethel M. Adamson,
daught_r, Laverne S. Blackard and Donald David Blackard, sons; that
no probate proceedings were had upon his estafe.- That`'his saiG `-
estate was insufficient in size to be liaDle for any federal
estate tax.
Affiant further says that the said Nellie Blackard died
on or about January 2, 1973, intestate, leaving the following
children as her heirs at law, namely, Ethel M. Adamson, Laverne
S. Blackard and Donald David Blackard; that the total value of
all her property as of the date of her.death was less than the
exemptions for Indiana inheritance tax affardod her B��s 4�'
that no probate proceeaings were had'tipan�TtOr`e9tate and none
are contemplated. .
� ��LL / •
.._�,-
Subscribed and aworn to before me, a Notary Public, on
this, the /� � day of September, 1978.,
���s74�l�*�a�7✓%,. ��-� --
otary u 1c.
A resident of, a..r^�+-tA-- County,
Indiana
My commission expires: /-6.�—�0
This instrument prepared by Mark P. Lock'xood, Attorney.
...; ,.. _..
._ • �
,, � � I,ocal Record oj Death
' �� � This is to Certify that our records show
. �te112e F Ft aakarA
----__
d�� Januarp 2. 1973ar Bedford, Indiana 74 �„�.
•o�rx e�t rw
IL�Ct OI OC4TM y!
•. O� �.
Primarycauseofdeathgivenwa■ Cwrahral Vaar�,la.. n�......__
Signed by �onaid M. Rerr� N.D. Pedford, In�ii r�na
..,.���.. e. �.o...
�OD��N
Funeral Director Fn�+g»a�� i.aa
-- — `-�i!'--ord Ind iana
. Placa of burial wglnut Hill Cemetery Port �rancn,• Indiana
�es�m
Dete of burial .iam�n..r �� �� 97�
-. Date issued— Tn u..o �A - 107� _ Signed � �
�--- �� �,y.
LAWRENCE COUNTY BOARD OF HEALTH
Bedford, Indiene �
a-s- � .. - - - -�
0
RECORD OF DEATH
�
�
GIB.SON COUNTY DEPAATMENT OF HEAL1'H
P&IIVCEfON, INDIANA
THIS LS TO CERTIFY, that our rn»rda show— 3AMU�J. ffiACKARD �ied
�.. Nov. 21, 1964 at 11s10AM Ft. Branch� Ind.
month . day yeas hoar of deatL �� ���� �� —
� .
�� Age at Death �Z
� yeaxs
Stgtun Ma rr 4 a�
write whether marrisd or �egle
� Primary cause of death given w�w Spin31 naraleit�
;; .
�; '
. Signed by E. V. Marchand� I� Hauti�t��o �i.
.;' - � . v�yeie9.n or eoramar � ndd,e,e -- ---
� �, .
, Place of burial or remov " -
`-,
-4
i
. name ot «metery - � -- - -- --
Date of burial ,� � ��?'i�64 Ta i n gyneTel �io�ci � ��n J^�
. � Fhnexsl MxxWr a� - � - �—
i
C
3EAG
�
��Cr. � c ��
SiBned _� � _
Gibsoa Connty Health Co aioner
Oakland CitY, Ind. 9/7/T8
�a� ��
Recorded locally in book No_ H-S� Page No- 6D �ied: ii/23/64 — —