Aff - Green, Katherine May_8/10/1978T�e a`.i_davi� �ur,iis:�ee siioc'_d i._ ;iriiar to the folicving:
STATE OF IidDIAVk )
COLNTY OF ��_) SS :
AFFIDAVIT FOR T�e1NSFEF OF ASSF.TS
:dITHOUT AD*fItiISTRr\TIOv
, being firsc duly sworn upon
oath deposes and says:
i
1. That �� ,� o �v., died on thc �G day of
19 (testacc), (intestate) wnile domi-
ci in '
� County, Zndiana.
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3
_a�t no petition for the appointment of a personal :epre-
sencative of his estate is pending or has been granted.
Ti�at forty-fi��e (45) days have elapsed since the dea[h o:
said decedent.
4. The value of the gross probate es�a[e less liens and encwa-
brances [hereon does no[ exceed five thousand dollars ($5,000).
5. That this affiant is a(widow) (widower) (dist:iSutee) of
said decedent and is entitled to receive without administra-
tion the following listed property from the person, firm or
corporation listed opposite�said property•sub;ect to the ��
liena and encumbrances thereon.
�IdPff. A\D r?DD'ciE�S OF
� LIEN OR PERSO\, �?it:? OF
KIND OF WHERE ENCUI�BRANCES CORPORATIO\T HOLDING
PROPERTY LOCATED VALUE IF AP+Y PROPERTY OF �ECEDHNT
,�
�
3�3, / �
This affidavit is made for the purpose of inducing the above named
holders of said decedent's property to turn said property over to thie af-
fian_t as provided by law. .
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=;�;��tiscr.l e1'_�a'�:3 sworn
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to before ne this
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� day oi _1���_�_19 '_f�
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Notary P�lic
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