Aff - Cline, Carol Sue_5/4/1967� . t 1
Form T M-S
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AFFIDAYIT
STATE OF INDIANA
COUNTY OF
Gibson � 55:
NAME
Cat�ol Sli@ Cline
1330 Darwin Avenue. Princeton. Indiana
ADDRESS
Deposes and says uponblE7Qor her oath that:
Caml Slie Tate, and Cardl �e Cline. are one
and the same person. This is for the purpoae
of changing name on p2roperty at 1316 Darwin Ave.
Iot # 63. Mc%ax Summit. Princeton. Indiana.
_ �./C=V�/P'Ci .�V l../�C�.itl J
SIGNED
Subscribed and swom to before me Ihis�day of
,9 �7::.:Y .
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_ �-: _ - %,
_ � ; NOTARY PUBLIC
_ ' , /. �" -/
My�commission expire � / � `�' a .
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