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Aff - Thompson, Eva J_5/10/198471�e affidaviL' furni:hed siiou.Ld be similar to thr. fo]lowinR: STA"1; OF I2::�IA:tA C0�7;TY �F CS : _� l �So 1� �, . AFFIDAVIT FOR TiL\\SI�EF OF ASSF:CS IdITHOUT AD�IIivIS'fR1TI0N ��•��S�rL,, being firsc dul.y sworn upon �_ on[h dupnsc;; and say : Y- 7.. 71i. "�/�v �_ u �.�d nn Cht: OI � �Iriy of . y1.'J�83(Ce�:L'nCe), (lntcal':iCC) wh(Jr. d�imt- cil d 't❑ _�k:�0.� __ Cuunt�•, InJi:m�t. � 3 4 'Ihar no petitian for the appoin[ment of a personal repre- sen.`.ative of liis escate is pending or has bcen gr.anted. 7iint for[y-_ivc (45; dnys have clapsed sinca thc desth of sairi dr.cedene. The value of the gross probate cs�ate iess ].icns and enc wr brances [herr.on does not exceed f:ive thousand dollars ($5,0��0). ��. 7"nat this affiant is a(widow) (coidower) (di.stributee) of said decedent and is enti.tled to receive without administra- � tior, the fol.locaing ].isted proper[y from [he person, firm or corporatioa listed opposite said property suUject to the � liens and encumbrances thereon. KIr�u nr- P R��:9?.I2'f1' IJI IliRl'. 1.00ATED VALUh; �9, 3a . l.l I•:N UR IiN CUP�f I'v1\ CL•' S l. i� Ah'�' idAFili Atdll AnDiiliSS OF PF.RSO�;, PTR7•! OR CORPOhA'C10Y HOi.DING PROPi'.R'IY OP Dtii,EDENT ' T:�i.s af;idnvit is made for tl�e purpose of. inducing the abovc named hoiders of said der_edent's pr.operty to turn said property over to thie af- flant as pr<,vi�ied by lzw. ` 1..,. ��� �i\y�� 9 �. _ z�� g��. ADllRESS Subscribed and sworn to before ne this � day of Not'/a Public SR.n�I`CL na� �a/'G !}y Cor,anission expires 5-„?,s.�� � . /� � vl./_ /� - — ---- - ----- �N�� - -N...�ae,� �a .\ �. Y��y �> t� �- _ ' ., 9-�-y== _ - � - : -'�-�^ _� — : `; . / (- /�