Aff - Crumbaugh, Patricia_1/26/1979Ti-�e a:fCdavi� f.:;rni.siicd s�ouid �e si�'__�: �� the foi2ou:ng: `
,
STA=E OF I::�I �V/��f � }
COL:VTY OF ,.��.�) :S :
AFFIDAVIT FOR TRA\'SFER OF ASSETS
WITHOUT ADPfIYISTRATIO�
�� , being firsc duly sworn upon �
oath deposes and says:
1. 'Ph ' ied on thc � day of
19 (�tace), (intestate) while domi-
ciled in _ County, Inliana.
2. That no petition for the appointment of a personal repre- '
sentative of his estate is pending or has been granted.
3. That forty-five (45) days have elapsed since the death of
said decedent.
4. The value of the gross probate estate less liens and encim-
brancas thereon does not exceed f.ive thousand dollars ($5,000).
5. Tnat this affiant is a(widow) (widower) (distributee) of
said decedent and is en[i[led to receive without adminis[ra-
tion the follocaing listed property from the person, firm oz
corporation listed oppo5ite�said property subject to the ��
liens and encumbrances thereon.
NAMT A\D ADDRESS GF
� LII'[J OR PP.RSON, FIR"i OR
KIND OF WHERE BNCUt�iBRAIQCL•'S CORPORATION HOLDIi G
PROPERTI' LOCATED VALUE IF fu�1Y PROPERTY OF DS;;£DENT
� l83, 5 �
� G /�
:r�is affidavit is made for the purpose of ir.ducing the above named
�:ol'��rs oi sai'a der_edent's property to turn said property ovcr to thie af-
_`i:nC 2s o-.OVlded by lsw.
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AFFTANT
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ADDRESS
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Suoscribeu's.r.d�.sworn to beiore ne thi� �� day of 19�
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