Aff - Bender, Joe_1/6/2009,
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JAN � 2009
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GIBSON COUs!TY %U01T0�
AFFIDAVIT FOR TRANSFER OF NtI\'ERALS ON AUDITOR'S RECORDS
DOROTHY M. BENDER, being first duly swom upon oath, says:
1. She is a competent adult.
2. She has personal kno�vledge of the matters stated herein.
3. She is the surviving spouse of Joe Bender, ���ho died testate in Gibson County, Indiana, on
August 16, 2008.
4. At the time of death, Joe Bender ("Decedent') �i�as the o�vner of an undivided fractional interest
in the oil, gas, coal and other minerals (collectively "Minerals") in and underlying the following described real
estate in Gibson County, Indiana:
The Northeast QuaRer of Section 36, Tow�nship 3 South, Range 12 West, in Gibson Count}',
Indiana, continuing 160 acres, more or less.
(hereafter "Real Estate").
5. That pursuant to the terms of Decedenrs Last Will and Testament, Decedent devised all of his
right, title, and interest in the Ivfinerals to the undersigned Dorothy M. Bender.
6. That the undersigned Dorothy M. Bender hereby requests the Auditor of Gibson County,
Indiana, to transfer all interest owned by Decedent in the Minerals to the name of Dorothy M. Bender as
survivin� spouse and devisee of Decedent on the records of the office of the Auditor of Gibson County, Indiana.
7. That there is oil production currently from the Minerals, and the tax code number for the
propeRy taxation concerning the oil production from the Minerals is 26-99-99-999-002.039-021.
8. That henceforth, property tax statements respecting the oil production from the Minerals should
be sent to the undersigned, Dorothy M. Bender, at 8766 S. SR 65, O��ensville, Indiana 47665.
ill /�y�'�ii,� 7�-,. �ndvr.�
` �rothy . Bender
.
STATE OF INDIANA
COUNTY OF POSEY
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Before me, a Notary Public in and for said County and State, personally appeazed DOROTHY M.
BENDER who acknowledged the execution of the foregoing Affidavit for Transfer of Minerals on Auditor's
Records, and who, having been duly s«�om, stated that any representations therein contained are true.
Witness my hand and I�'otazial Seal this _
M� o�ty of Res�dence is:
County,
State of In ana and
My Commission Expires:
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(Printed)
This instrument prepared by John P. Broadhead, Attomey at Law
Bamberger, Foreman, Os�eald and Hahn, LLP
, P. O. Bos 6�7, Evansville, IN 47704
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I AFFIRM, �'DER T E PENALTIES FOR PERJURY, THAT I HAVE TAKEN REASONABLE CARE TO
REDACT ACH SOC L SECURITY NUMBER IN THIS DOCUMENT, UNLESS REQUIRED BY LA��J.
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Signatur Printed Name
L:LLIB\DOCS�50784W.FFIDW 25268.DOC
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