Aff - Grider, Marjorie_5/21/2009//' . . .
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AFFIDAVIT OF DEATH AND HEIRSHIP
OF GAYLORD GRIDER
The undersigned; Marjorie Grider, �vhether one or more, being first duly sworn, upon
oath deposes and sa�5:
The undersigied �vas personally acquainted ���ith the above-named deceased respecti��ely
fors� years and bears the following relationship to said deceased, to-�3�it: �vife.
The deceased departed this life at Harbor City, Califomia on or about July7, 2007. he
being %`� years old at the date of death;
The undersi�ed is well acquainted �rith the family of said deceased and with those who
would constitute the deceased's heirs under the laws of the State of Indiana: and
!'he followine statements or answers are based upon the personal knowled� of the
undersi�ed and are true and correct:
PART I - GENERAL INFORAIATION
Did the deceased lea��e a Will?
\io.
2. Has the estate been admitted to probate?
N/A
3. Give the names and residence of each person to �ahom the deceased was married
during his/her lifetime toeether with the other information requested:
Date of If not livine. If divorced.
Name of Spouse Marriage date of death date and place Address
�4arjorie Grider 1�{� N/A N/A 26200 Frampton Avenue
6�'�'� Space 33
Harbor Citv. Califomia
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Did deceased leave any unpaid debts?
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MAY � � 2009
�/ .i7-�oo-000. a63-oi7 �aa�G'i,�s.5
(Q GIBSON CCUNTY A DI70R
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PART II- CHILDREN OF THE DECEASED
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�. Give names of all children bom to deceased toeether with other information
requested: y
Date of If not li��ine. If divorced.
\'ame of Spouse Mamage date of death date and place Address
Ste��en Grider ,�/�Z/g� N/A N/A 25469 Alder Peak Avenue
Santa Clarita. CA 91337
Kenneth Grider ✓/L/�z \'lA N/A 638 Calli De Arboles
Redondo Beach, CA
90277
Lisa Volz ��y/y..r� N/A N/A 1225 Date Avenue
� Torrance. CA 90�03
6. Give the names of all adopted and/or illegtimate children of the deceased together
�vith the other information requested and desi�atine whether adopted or ille�timate.
\'one.
7. Give the names of all children of any deceased son or daughter of the deceased,
includine children of a deceased adopted son or dau�ter.
\'one.
% ✓ �GC�t 2�-f.� �.�l�L� c��
�4arjoriei rider; Affiant
STATE OF CALIFOR��'IA, COUNTI' OF Lc+S Ah.�E2.�� ) SS:
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Subscribed and s�� om to before me this !4 � dav of �4av. 2009
Signamre f\'otaryPublic
199i3 SC .S'CNC<JfYt�Z
Printed Name of \rotary Pu ic
My Commission Expires �nic ,� y c�Vi
Resident of (l� �/vs�z.E� Counry; CA
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Commiuion # 1592421
� y Notary P�blk - CaliforNa �
los Mgeles Counfy
My Cortun. E�Ires Jun 29. 2009
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