Aff - Frederick, Dallas_5/29/1984.. . � .... ... ... ...:..... ...... :. :.....: . ..v::.. ..: ...�. ......._......"""�..'"_'...�'�.���'"Y.....�rf.o.r�
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The affidavit furnished snould be similar to the following: •
STATE OF INDIANA �SS:
COUNTY OF GIBSON )
,'AFFIDAVIT FOR TRANSFER OF ASSETS
� [JITHOUT ADMINIS'fRATION
Dallas Frederick being firsc duly sworn upon his
�
oath deposes and says:
1. That Barbara D.
Frariari rk died on the lOth day of
April 19 $Q (testate), (intestate) while domi- .
ciled in Gibson County, Indiana.
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.
s
4. The value of the gross probate escate less liens and encinn-
brances thereon does not exceed five thousand dollars ($5,000).
5. That this afFiant is a(widow) (widower) (distributee) of
said deceden[ and is entitled to receive without administra-
tion the following listed property from the person, firm or
corporation listed opposite said property subject to the
liens and encumbrances thereon.
KIND OF
PROPERTY
Wages
WHERE
LOCATED
v
' � LIIIV OR
ENCUMBRANCES
VALUE IF ANY
$389.43
, NAt�tE AND ADDRESS OF
PERSON, FIRM OR
CORPORATION HOLDING
PROPERTY OF DECEDENT
�
This affidavit is made for the purpose of. inducing the above
holders of said decedent.:s''propeity to turn said property over to th
fiant as provided by law:'�
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ADDRESS
Subscribed and swcrn to�before me this �day of `�% 19�
. . ._ / /Notary P lI/ic - .
.ScL/Iqh[. /<ai/ !�0/^f' •
My Coimnission expires S-,a7�j ��, �
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