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 :
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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.
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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.
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1.00ATED
VALUh;
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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 �. _
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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./_ /�
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