Aff - Hasselbrinck, Leo E_5/16/1958� .�
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PROOF OF DHATH AtiD HBIR�p..
STATE OF It4DIANA�
SS:
QOUNTY OF (#IBSON�
Leo.E. Hasselbrink of RR No. 1, Prineeton� County eno' s�cete aforesaid, of
lawFul age, beiag first duly sworn� aceording to lap� deposes ead says that he aas
weli and persoaaliq acquainted with EliaabeLh S. Hasselbriok during her lifetime;
tbat the said Elizabeth S. Hasselbziak depazted thia life at or near. the to�a of
Pozt Btanch, in the Countq of Gibaon� and in �the State of Indiana� on February 4�
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,� being approxiaratelq 73 qeara of age at the time of her death.
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j /� Af&ant fuzther swears�that the following is a true� correct and complete
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^ y �tenent of �femily hi8t�ry of sad decedent and shome who are the sole aad
�� .y= heizs at w:�y / �1
,r i �v �i�' '� ���/b 7 -
; i� 6�sthe deceased�ie�.�or' sRn �7 ldarried
;o; ,� V o�
� I isueh husband n '.in� Ye !:.
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' 'Na�e of husband. Hasaelbz nk
If married more than e� ao state, giving namea. Eiizabeth S. Hasselbrink was
only raarried one tine and that marriage �sas to the atrove d°signated John H, Has-
seibrink, vrho is decedent'e aurviving husband.
Md deceQeat ever�have any children? No
If so, how cazty? None
If decedent had anq children� nac+e all of them, bnth livipg aad dead� and gine
ali information cailed for oa the follmving blanka, Decedent left no children�
living or dead.
State whether oz not deceased heiss left atty Qeaceadent8, giving names aad ages,
No deceased heirs and thus no descendents of any deceaseQ 6eir.
Thst affiant's decedent, Elizabeth S. Hasaeibrink� left no parenta aurv3ving�
her father, George C. Sollman , and her mother, Blizabeth M,
Sollman � having each predeceased the said Slizabeth S. Hassel-
brink.
Did the decedent leave a vrill or wiils disposing of any part of her propettq? No
Plas there_,aay adciniatration of the estate of the_decedent? No
If so� arheze was the adainistration had? No adoiniatration hnd upon the eatate of
Eliaabeth S. Hasselbrink� deceased.
Affiaat further eays that he knows of his own peraoaal kaowledge that all debta
against the estate of Hlizabeth S. Hasseibzink, decease6� have been fuily paid and
diachatged.
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Leo H; Hasselbrink, fiant
Subaczibed ead avorn to before me this lbth day of Maq � 1958.
Mq covffiiesion expires l� �y /,%�'+y'�
Noveaber 7� 1960. ��_. Notary Public