Aff - Jones, Helen S_2/6/1981liie a!iidavit furnisiied stiould be si^�i:ar
STA'�t: OF I:F��[ ;dA, �
COU"::TY Oi' �SS: �
to [hc foilovinq: �''� � _ �9��
AFFInAVI'C POf: Ti.A,:SPi:F OF ASSF,'PS
4J1'PHOUl' M�IiY1:5'CRATIUN
being f.f.rsC dul.y swocn upon �
oa[h dapnscc: m� ys: ,
• � .
1. 7uat �' died on Chc ��_ �ny of
�_1 (testace), (intestate) wnile domi-
cilea in Z County, Indiana.
2. 7i�at n� petition for. the-appointment of � personal repre- ,'
sc;it:ati.vc of l�is esr.ate i.s pendin� or has bcen gr.anted.
!�7
7i�at fnrty-five (45; days h�ve el�psed since the death of
said decedent.
11:e value of the gross probn[e estate Less ].icns and encum-
br�nces thereon does not exceed i:ive thousand dollars ($5,000).
5. ?nat this affinnt i� a(�oidow) (wldowcr) (distrlbutcc) of
s�id decedent and Ls enti.cled to receive w.irhnuc adminisr.ra-
` :.i.or. tbe fo].lewing Jisee�l property f.r�m the person, f.irm or
..orporntiun lisCed nppo�t[e sni.cl propert}• sub;ec[ �o thc
1Lens nnd encumbrances Chercon.
;Q:1P[]i A\D APDRfSSS OF
. LIlii� i1R PHRSOV, PIR:`1 OR
KIi ❑ (1F WiIG[:fi IiYCU�(13R,1KCIiti COI;PORATION }?OI.DI�G
PRI�I'F.R'P.' LOCATED VALUI( IP A;l' Pi;UP1iRTY OF DGCEDE� i
.�/ a�, a2 �y. a a
7'tii.s ntfidavir. is made for. the purposc of. inducing the above named
holders of �:,�id deredent�s pr.operty [o turn eaid property ovcr to this af=-. ,
fiant as prnvidccl Uy ]n;a. �: ` o'-
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--f-' ='��"��.IANT = - ' �. `. :y_-.J'!'E
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ADllRGSS - G^- �� �,;
Subscribed nnd sworn to bef.ore me this ��ny of 19 p�`
t�;y Co;:cnissi�n expires �� �— �
Nctnry Publ
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