Aff - Jenkins, Imogene_12/17/1973�
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The affidacit furnished snould be similar to the following:
STATE OF IND ANA - )
COIJh'TY OF �'�Q�,;;,. � SS :
oath deposes
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�;-, AFFIDAVIT FOR TRANSFER OF ASSETS
,��` SdITHOliT ADPIINISTRATION
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�; eing first duly sworn upon �
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says:
�died on the •? / day of
testate)', (intestate) while domi-
' County, Indiana.
That no petition for the appointment of a personal repre- '
sentative of his estate is pending or has been granted.
That forty-five (4�) days have elapsed since the death of
said decedent.
4. The value of the gross probate estate less liens and enc�-
brances thereon does not exceed five tho�isand dollars ($5,000).
5. That this affiant is a(widow) ��^?=--=r) (�;�.��-����) of
said decedent and is entitled to receive without administra-
tion the follocaing listed property from the person, firm or
corporation listed opposite said property subject to the
liens and encumbrances thereon.- ,
NAME AND ADDRESS OF
� LIEN OR PERSON, FIRM OR
KIND OF WHERE ENCU2IdRA:\CES CORPORATION HOLDING
PROPERTY LOCATED VALUE IF ANY PROPERTY OF DECEDENT
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This affidavit is made for the purpose of inducing the above named
holders,of said decedent's property to turn said property over to this af-
fianT. as provided by law.
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- '-,.!,� ADDRES
Subscribe3 and sworn to before ne this /%�i day of ,�y% 19 7-3
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Notary Public
My Co�nission e:cpires �T/- ! �`J
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