Aff - Gottfried, Mariloys_10/5/2007A
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ilbovc'fhis I.iuc I�or
S'vliVl �'OIiSIIIP iAI�I�IllAVI'I'
7 homas L. GoUfricd, bcing �7rsC dul}• sworn oi� oa(h, dcposcs aiid says:
L Your blariloys CollGicd dicd on iblarch 2, 200G a( Roscvillc, i��1N.
2. "1'lial Iv]arilo}'s Gotltriccl by 1Varrant Dccd da(cd August 20, 19I�, filc�l for rccord i�ugusL 2C, 19IS, as
Documcnt No 9S-G125, rclaincd a lifc cslatc in and to thc follo�viug dcscribcd real cs�atc:
Scc attachcd Lzhibit A.
3. 'I'ha( all fuucral cxpcnscs in conncclion wilh Lhc dcath of said dcccdcnl havc bccn paid in full.
4. 'I'hal all of lhc asscts of said dcccdcut wl�ich �vould bc iucludablc for l�cdcral Ls(atc "1':i� purpascs,
uiciutiu�g joint uauk accouuls and lilc iusurancc on dcccdciit's lilc wcrc noL su�ff +ii--L cccssitalc
paymcnt ol Pcdcral Pslatc'Cax. // /
Purthcr affiant saycth uo(.
Subscribcd aud sworn lo bcforc mc
this �'�day ol ��,,,.� 2009f.
�4�-%� it�t�
Signatwc of1'olaiy Yublic
D9y Commission 13xpires --(� 1'�O f(�
I afiii�n, widcr lhc pcnaltics Corpcijury, that 1� lakc» rcas�, . � • ,-' '}y uumber in
tl:is �ocumcul, unlcss rcquircd by laiv. _ ,o . T__��_ _
'I'homas 1�. C' lfr' �d
Couuly of Kcsidcncc: IZ, mscy County, 1�9 iimcsola
'fhis Ins4umc�ri prcparcd by: Lany K. I louk, 1'.A.
Larry IC I Ivuk
1 G1 1\Vcst Couuty Raad 13, t/315
Roscvillc, i�9N 551 i3-4053
G51-G33-251G
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OCT 0 5 2007
�4� ��G
GIBSON COUNTY AUDITOR
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Eihibit A
An undivided one-third (1/3) interest in and to the:
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The South half of the \ortheast Qua�-ter of Sectioa Thirt} -Oae (31) and the \o; �h Half of
the �orthwest Qua�-ter oi Section Thirty-Two (32); and also the Soutnwest Quarter of the
Southcvest Quarter of Section T«ent}-?�ine (29); all in Township One (1) South, Ranee Nine
(9) R'est, contauung in all Tcvo Hundred (200) Acres, more or less; Gibson County, Indiana.
j
DECEDENTSNAME
_�
� DECEDENTS ALIAS
DEATH CERTIFICATE
MARILOYS WOODS GOTTFRIED
, SEX, SOCIAI SECURITY FEMALE
_ NUMBER, MAIDEN NAME
RESIDENCE(COUNTYAND RAMSEY
� CITY,STATE)
• DATE AND PLACE OF BIRTH APR�L 24, 1925
MARITAL STATUS
` S�OUS� S NAiJE
, PARENT(S) NAME(S)
DATE OF DEATH
PLACE OF DEATH
(COUNTY AND CIN)
FUNERALHOME
CAUSE OF DEATH
IMMEDIATE
UNDERLYING
OTHER CONTRIBUTING
CONDITIONS
MANNER
CORONER, MEDICAL
EXAMINER OR PHYSICIAN
0
WOODS
WIDOWED
HERBERT ALLEN GOTTFRIED
DARWIN WOODS
GRACEFERGUSON
MARCH 02, 2006
RAMSEY
ROSEVILLE MEMORIAL CHAPEL
RESPIRATORY FAILURE
ALZHEIMER'S DEMENTIA
ROSEVILLE, MINNESOTA
PRINCETON, INDIANA
ROSEVILLE
ATRIAL FIBRILLATION � � � � �
� 1�J�1�0.
OCT 0 5 2007
NATURAL `-y„� � �
p �!
RICHARD D GLASOW, M.D.
GIBSON COUNTY AUDITOR
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
�,yw�ouypi� OFFICE OF THE STATE REGISTRAR. DATE FILED: MARCH 03, 2006
��TI� ESj���:
: i� ?to�Fp�� PLACEISSUED: RAIdSEY (�
_\� - >�9. ��..I�OJ��
�...�,y,�:=� DATE ISSUED: MARCH 07, 2006 STATE REGISTRAR
IIIIIu II uIIIIIIuI�IIIuIIIIIIII Iullllll
*0059772*