Aff - Gottfried, Thomas E_10/5/2007Q
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COUN7'Y Ol� 1LA�ISLY
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Thoroas E. GotlGicd, bcing �7rsf dul}• sworn on oath, dcposcs aud says:
L �'OUf A'�ei"IIO}'S UOIIGIC(I (IICII 011 D'IeICII Z, 200G at Roscvillc, D•IN.
2. "I'lial D1ariloys Gattfriccl by �4':�rrant Dccd dated August 20, 19I8; filcd for rccord August 2C, 1993, as
Docuntcnt No 9S-6125, rcfaincd ;i lifc csfatc ii� and to thc Collowing dcscribcd real cslatc:
Scc attachcd Lzhibil A.
3. '1'hat all fuucral cxpcnscs in conncclion rvilh Lhc dcath ofsaid dcccdcnUiavc bccn paid in full.
4. 7'hat all of thc asscts of said dcccdcul which would bc includablc tor 1�cdcral Lslatc '1'a� purposcs,
;iyudu�g joint bauk accoun(s aud lilc iusurancc on dcccdcnt's lilc w� nol suffscictt{--(c�cccssjlalc
�a mcnL of Pcdcral P_slatc'1'az. � �
I�wthcr aC�ant saycth not.
Subscribcd and sworn to bcforc mc
lhis �'�clay o1 �J�,.�.�g� 200�!.
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Signatwc of Nolaiy Public
n1 Commis i 1� ( �—al 1(�
1'homas L'.
Cherie R. Ewald
Notary Public
!.!innesota
Gummissiai Expires January 31,
ACGanL
y s o» �xpucs __ �— Q ,
I afTinn, undcr thc pcnaltics for pc�jmy, lhal I• takcn rcaso � numbcr in
tL•is docuutcul, uulcss rcquircd by law. _ ,v �' �_ __
Thoinas 1;. Ci lft -d
Couuty oCKcsidcucc: Hamscy County, I�tinncsota
'1'his Inslitimcnt prcparcd by: Lany K. liouk, P.n.
Larry IC I louk
1 G 1 I 1Vcsl Counly Road 13, l/315
IZoscvillc, i19N 55 1 1 3-4053
G5l-G:53-251G
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OCT 0 5 2007
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GIBSON COUNTY AUDITOR
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Eahibit A
An undivided one-third (1/3) interest in and to the:
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The South half of the Northeast Quarter of Sectioa Thirty-Oae (31) and the Nor�n Hali of
the Nonhwest Quarter of Section Thirty-Two (32), and also the South�vest Quaner of the
Southmest Quarter of Section Twenty-Nine (29); all in To�vnship One (1) South, Ranee?�ine
(9) «�est, contairuna in all T�vo Hund;ed (200) Acres; more or less; Gibson Count}�; Indiana.
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�'��- DEATH CERTIFICATE
DECEDENTS NAME � MARILOYS WOODS GOTTFRIED
DECEDENTS ALIAS
SEX, SOCIAL SECURITY FEMALE
NUMBER, P:WIDEN NAME
RESIDENCE (COUNTY AND RAMSEY
CITY,STATE)
� DATE AND PLACE OF BIRTH APRIL 24, 1925
"` MARITAL STATUS
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= S�OUS� j NAiv7E �
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=��.E PARENT(S) NAME(S)
'�-_
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��'� DATE OF DEATH
;:i
j3. PLACE OF DEATH
�3c; (COUNTY AND CITY)
-.�?: FUNERAL HOh7E
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'�=� CAUSE OF DEHTH
y0° Ih9MEDIATE
yp
�S'� UNDERLYING
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'�-� OTHER CONTRIBUTING
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'i. CONDITIONS
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3� MANNER
`�^ CORONER, tv7EDICAL
EXAFAINER OR PHYSICIAN
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314-20-8974 WOODS
WIDOWED
HERBERT AI.LEN GOTTFRIED
DARWIN WOODS
GRACEFERGUSON
MARCH 02, 2006
RAMSEY
ROSEVILLE MEMORIAL CHAPEL
RESPIRATORY FAILURE
ALZHEIMER'S DEMENTIA
ROSEVILLE, MINNESOTA
PRINCETON, INDIANA
ROSEVILLE
ATRIAL FIBRILLATION � � � Q—i �
1 1J
OCT 0 5 2007
NATURAL `-y„a� � �
RICHARD D GLASOW, M.D.
O'�
GIBSON COUNTY FUDITOR
4194 LEXINGTON AVE N, SHOREVIEW, MINNESOTA 55126-
6 2 A- 0 0 5 9 7 7 2 THIS IS A TRUE AND OFFICIAL RECORD OF THE DEATH REGISTERED IN THE
OFFICE OF THE STATE REGISTRAR. DATE FILED: MARCH 07, 7006
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:,,�tdJ•.G� f PLACE ISSUED: RAMSEY
� ��Q. Co.,.�,.
��.�� " DATE ISSUED: MARCH 07, 2006 STATE REGISTR.QR
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