Aff - Folsom, Clifford A_2/28/2011. , .. .�.... ......
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STATE OF INDIANA
COUNTY OF GIBSON
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IN RE: CLIFFORD A. FOLSOM
decedent
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AFFIDAVIT FOR TRANSFER OF REAL PROPERTY
1. That the above-named decedent died intestate on the 16'" day of May, 2000, while
domiciled in Gibson County.
2. That forty-five (45) days have elapsed since the death of the decedent.
3. That no application or petition for the appointment of a personal rcpresentative is pending
or has been granted in any jurisdiction nor is any administration contemplated.
4. That the following named persons are the only heirs of the decedent:
TiSheena Clifton-Adult Daughter Ciifford M. Folsom-Adult Son
12121 S. State Rd. 61 411 N. Lincoln
Lynnville, IN 47619 Oakland City, IN 47660
Derrick D. Folsom-Adult Son
106 E. Rosedale
Ft. Branch, IN 47648
5. That the value of the decedenYs gross probate estate, less liens and encumbrances, does
not exceed the sum of the allowance providcd by IC § 29-1-4-1, the costs and expenses of
administration and reasonable funeral expenses.
6. That among the decedent's probate assets is a parcel ofreal estate which was owned by the
decedent located in Gibson County, Indiana, more particularly described as follows:
A part of the noRhwest quarter of the southeast quarter of Section 18, To�mship 2
south, Range 8 west, bounded as follows: Beginning 50 feet south of the southwest
comer of Lot No. 8, in Block I`'o. I, Beasley and McConnell's Addition to the town
ofOakland City, now Oakland City, Indiana and running thence south 75 feet; thence
east 140 feet; thence north 75 feet; thence west 140 feet to the place of beginning
being within the corporate limits of the city of Oakland City, Indiana.
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Commonly known as 411 N. Lincoln, Oakland City, IN 47660
7. That the following list of persons, firms, or corporations are the only creditors of thc
te: None.
8. That the individuals cntitled to ihe real estatc as a result of thc deccdent's dcath are the
�o�edent's heirs at law as provided under the laws of intestatc succession, namely:
TiSheena C1iRon-Adult Daughter Clifford M. Folsom-Aduit Son
12121 S. State Rd. 61 411 N. Lincoln
Lynnville, IN 47619 Oakland City, IN 47660
Derrick D. Folsom-Adult Son
] 06 E. Rosedale
Ft. Branch, IN 47648
9. That the gross value of the estate of the dccedent, Clifford A. Folsom, as determined for
the purposes of Federal Estate taxes, was less than thc value required for the filing of a Federal
Estate Tax Retum. As a consequence thcreof, thc decedent's cstate was not subject to Federal Estate
Tax.
10. That the decedent's estate was not subject to Indiana Inheritancc Tax.
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Cliff d . Folsom
STATE OF INDIANA ]
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COUNTY OF GIBSON ]
Subscribed and swom to before me, a Notary Public in and for said County and State, this
�1 day of �'2Jpt umt w�_, 2001.
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�,,p�(ZR�E �. Sm�rt'N Notary Public
My Commission Expires:
Oy -b �-20�"l I residc in Gibson County.