Aff - Mitchell, Shara_10/8/1986i
�
STATE OF INDIANA �SS:
COUNTY G/,(3 � o/!/ )
AFFIDAVIT FOR TRAI�SFER OF ASSETS
WITHOUT ADMINISTf2ATI0h
iK'�wh'ti' �� 1<OL%, being first duly sworn upon �/C�J -
oach deposes and says: ,
1. Tha[ � died on the 3� day of _L����{��190 S�
(cesta[e), (in[es[aLe) while domiciled'in Coun[y,
Indiana.
2 Thac no peti[ion ior [he appoinLment of a personal represen-
[acive of his estate is pending or has been granced.
�- .�i- �,�
3. Tha[ for�y-five (45) days have elapsed since Lhe death of said
decedenc.
4. The value of che gress probate estace less liens and encum-
brances [hezeon does not exceed eighc [housand five hundred
dollars (58,500).
S. Thac �his a:fianc is a(widow)(widower) (dis�zibu�ee) of said
deceden[ and is er.citled co receive wichout adminiseration the
folloving lisced proper�y from �he person, firm or corporation
lis�ed opoosice said properey subjec[ ce che lizns and encum-
6rances chereon.
KIND OF
PROPERTY
�-• �-
i
LIEN OR
�,�r� ENCUMBRkNC�S
LOCnTED VALUc IF ANY
3�9�.�.3
This zifidavit is made for
holders of said decedent's propercy
fiant as provided bv law.
NA."lE P.hD ADDRESS OF
PERSO�, FIRM OR
CORPORATIO;: HOLDING .
PROP.RTY OF DECEDENT
che purpose of inducing [he above named
to [urn said prooert� over [o [his af-
,
/y� �_�"�� ��,ti`°.�
�7JLLL'.,A � ' -!�'_'�xxX nnSA.LHt"�Ai��
AFF ANT
�2 3 0 5 A-�_—Y� SN
ADDRESS
Subscribed and Sworn to before me this � day of Q(��,�i-C/� 19 � _
� iJi/ '�li,tb / 1Gt— �t--
, Notary P lic* � ' - _
/ .'�.
Sa.nt�na. !S�-� vare.: �•._ ._ \'�
County of Residence ��� ° J �y���,���
My commission expires 5-a7S-lD �%�-� -w'� �'-`""�" �'
* May also be acknowledged before a clerk of the circuit court, or other officer
..,i.r_h_aonor.a.Lnnvar._tn_administer_oaths.__-----_ - -------�--