Aff - Bender, Patrick_06/27/2008 (2)� � • AFFIDAVITOFHEIRSHIP,�pi�•
A_i1R5MIP OF PATP;CK BENDER , DECEASED
STqTE OF ' �NDIANA §
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COUNTYlPARISH OF GI830N � 6
FOR PLAIN'S USE ONLY
?ROP�RTY 01-940113
�UM6ER:.
OWNER NO. 0429025
DOC NO.
INITIALS: MDIM�F
Shdwn I. Bender (°AFFIANT), BEING OF IAWFUL AGE, AND 9EING FIR57 DULY SWGRN, UPON OATH DEPOSES AND SAVS:
TH0.T AFFl4NT IS WEII ACaVAl4TE01M7H THE FAMILY OF THE ABOVE NAMED DECEDENT AND WAS P"eRSONALLY WELL ACOVAINTED 4dTiH THE DECEDENi GURING
D2CEDENP� LIFCTI\1c, FiAVING KNONLY DECEGENT FOR nineteen �19� YEARS, AND TF!AT A%FIA4i 5FARS THE RELATION<HIP OF
SUrV1V1RCj SP01152 TO TNE DECEDENT, AFFIANT FURTHER RcPRE5ENi5 TFWT THE FOLLOWiNG STATEAfENTS ANG INFORNv1TI0N GNEN
AFE 6AScD U?ON TNc PERSO`lAL KNO�N EDGE OF THE AfFIAN j ANO A�E TRUE A4D CORRECT:
RRUFN A GOPY OF
o�.ni c�rxn.icnre
vmm �tis coRm
II. PROPERTY
Owensville I Gibson
OID�ECEOEYiO�WTMEFEAL7ROGERiYCESCFIBEDW �YE3
ExHIBR'A'ATiACHEDMEPEfOi � pp
• i . . �, _ � eKCa 1 � YES
TME FEiL PROPERTY GESCRI9ED I V�%HI9R'A' ATTACH2C
HEPETO'! � NO
III. MARRAL HISTOR7 0h utGtUtN l
NAME OF SURVIVING SPOUSE
�II None. Ente� "NOne')
AD�RESS 8 SOCI4L SECURITY NO.
NAME OF PR�E7L�pa E'POUSE�S)
AUDITOR
Shawn I. Bender
9780 South State Road 65
Owensville, IN 47665
DA7E OF BIRTH I DATE OF OEATH
4 VE3, DATE GFAGCUI3RI�N
If YES, DATS CF ACOVISfil09
ENDEO eY
❑ DIVORCE
� DEATH
[] DIVORCE
f� DEATH
❑ DIVORGE
f-I DEATH
ZN � 47665
�"�" SEPAFAi�PFOPERiY
�i CGM\tUNry?RO?'cn�Y
� SEPPRaTcPROPER,'
�j �pVM�4IttPROPERN
DGTE OF I DATE OF OEATH
DIVORCE
158< BedZl�)
(IF NONE, ENTER
N/A
�
BIRTH
�
MAILING l+D�RESS
PARENTS'NAMES
VII. �LEASE PROVIDE BELOW, THE NAMES OF ANY SURVIVING PARENTS, BROTHERS, SISTERS AND CHILDREN OF OECF�ISED BROTHERS
AND SISTERS. IComplete only If no SuNivinB 3Pouse or ChlldrenJ.
ENTER °NONE'� I TO DECEDENT I BIRTH
SIGNATURE
OF AFFIANT
MAILING l+DDRESS
L�. %/�1J�7,��L
MAILING
ADDRESS 9780 South State Road 65
CITYISTATEI �,�,ensville, ZN 47665
ZIP CODE
PARENTS' NAMES
Subscribed and s���orn to befor= me this 6th day of December .�� z�� ,;,,, �� •� •..,,
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: V;��...� .�%i,�.�'..
:`,J . �' '�, .-
Tnis instrument prepared by: 'a': yK � J .�; �..
y //� /1
William H. Bender, Attorney at Law l�Li//� �� r n!�I �. G�Cr���i J= `''
NOiASYPUoI' _ -• �-
� • � p-ll� . Li'
Kathleen M. Vaughn `�;"��i;._ � : `� ;'
17 W• Mdln StY2et� P.O. BoX 430 �OTTFYarftL�iEDAAMS. •�.•�'
�., N� ,..
10/09/2008 ''� �
Poseyville, Indiana 47633 PAy Commission Expires �O'����,,,..... ��°`—
Phone ( s ) : 812-874-3636 or ( 812 ) 985-2102 _.. '�^'°°'�. __..
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EX9IBIT "A"
Property: O1 940113 COLUMBIIS SMITH
N/2 NW/4 S�C 13, i35-R1947� GIBSON COUNTY, ?NDIANA.
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