Aff - King, Dorothy S_9/20/2005,�
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AFFIDAVIT OF NO INHERITANCE TAX DUE �'� ���
STATE OF INDIANA � SEP 2 0 20D5
) SS: �,
COUNTY OF Gibson ) /�r�G_ .C/"�
618SON COUi\ i Y AUDITOn`
Re: Dorothy S. Ring ,deceased
Address of Decedent: �st 4th St. , Mt. Carmel, IL 62863
Counry of Decedent's Residence: uabash Councv. Illinois
Social Security Number of Decedent: 331-40-8428
Date of DecedenYs Death: Dece�ber 26. 2004
Charles w. King (name of affiant), being duly swom upon oath, states:
I am familiar with the facts set out in this affidavit as the Eaecutor (state relationship of
a�ant to Decedent or DecedenYs estate) of Decedent or DecedenYs estate.
No inheritance tax is due by reason of DecedenYs death, because no transferee receives taxable
transfers in excess of such transferee's exemption from inheritance tax as listed herein.
Following is a complete listing of ali transfers subject to inheritance tax by reason of DecedenYs
death (attach additional pages as necessary):
Description of Property
An undivided onrhalf (�
Manner of Transfer
Iast Will and Testament
interest in the fractional of Dorothy S. King,
part of the Southwest
Quarter of Section 12,
Township 2 South, Range
13 West, Gioson County,
ZN, containing 57.05
acres, more or less, and
associated oil royalty.
admitted to probate as a
foreig❑ M111 0❑ May 20,
2005 in the Gibson
Circuit Court, Cause
No. 26C01-O505-FS-43
Total Value of All Taxable Transfers by Decedent
Date of Death Value
E. • 1�1 11
• ��1 11
' Once completad, this fom is confldenGal pursuant to Ind. Code §o—s.1-12-12. To comply with Administretive Rule 9 and
Trial Rule 5(G) this torm is marked 'NOt for Public Access' and is required to be filed on light green paper if it is filed tor an
otherwise public astata.
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g is a complete listing of the Vansferees of DecedenYs taxable Vansfers and the value of
nsfers (attach additional pages as necessary):
Name of
Charles William Ring
Mary Suzanne King Bires
Relation to Decedent
Son
Total Value of Ali Taxablo Transfers by Decedent
Dated:
ILLINOIS
STATE OF pVCA1�A174� )
) SS:
COUNTY OF �>/��/.�i� )
Value of Transfer(s)
$9,500.00
Exemption
i. �1 111 11
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Signature: �'�--d�-� �v���� `��t
Printed: Charles William Ring
Address: 1507 Troy Rd., P.O. Boz 277
Edwardsville, II. 62025
Before me, a Notary Public in and for said County and State, personally appeared �ries
Wiliiam King , who acknowledged execution of the foregoing document and who, being duly swom,
stated the representations contained herein to be true.i,
WITNESS my hand and Notarial Seal this � day of � , 2005
"OFFICIAL SEAC' (Signature) /j ,"
�9argr�ret A. Dallmier (Printed) ,�-
��otary Publiq Statc o( Illinois Notary PVblk
Aty Commission Ezp.O,/19�2007 t
Counry of Residence: �ndiscn
My commission expires: �'����
Instructlons for Use of Affidavit of No Inherftance Tax Due
This fortn is prescribed pursuant to Indlana Code 6-4.1-4-0.5. It may be used to state that no Inheritance tax is due es a result
of Decedent's death after appllcatlon of the exempUons provided by Indlana Code 8-4.1-3. The afidavK may be used onfy for a
decedeni whose taxab�a transfers ta each transferee are less ihan that transferee's exemptions. If iransfers to eny transferea
exceed that Vans(eree's exempUon, this aftidavit Is not avallable.
All of tha properry Vansferzed by the Decedent by taxable Vansfers shouid be induded in the list ot taxable trarofero hereln
wi�h Lh_ pro;e ,ry C=scrbsd, wlfh !; �a na';�re et L�a Lars(ar Cesu:beC, arC •.vIL`� `e da�v cf Ceaw •:alue � ��a Lanafarta�i propar��
Ilstad. If real property trans(ers are inciuded, the Iegal descriptlon o! the property should be Induded. Use attachmertLS If naces-
sary for such descdptlons: -
Each recipient of taxable Vansfers by Deccdent should be listed by name wl;h the transferee's relationshlp to Decedent, the
total value o( property Vans(erred by Decedent W him or her, and the amount o( the transferee's exemptlon. .Ulowable exemp0ons
are unlimi;sd for Decedent's surviving spouee and for qual�ed charitable entitles; 5100,000 tor anceston and descendants oi
Deceden;; 5500 tor Decedent's brothers, sisters, descendanb of DecedenYs brvthers and sisiers, and spouses of DecedenYs
childran; and 5700 (or all other trensferees.
If real esate Is Included in the property subject to taxable transfers by Decedent, the at�davit may be recorded In ihe oRCe of
. the counry recorder. The affidavit must include the legal descriptlon of such real property ta be so recorded.
If Indiena Code 6�.7-8-4 requires consent to Vansfer personal property Iisted on this affldavit We affidavk may be eubmitted
to the coun,y assessor to asiablish that consenting to such trans(er will not jeopardlze collectlon o( inheritance tax.
Recording this aftideWt wl;h the counry recarder wlll tertninate the statutory tlen on such real esiate (or inheri'ance tax.
SimllaAy, submisslon of tha at�davit to the courriy assessor In the DecedenYs counry ot residence dlscharges the Ilen on persanal
property (or Inheritance tsx. Such liens may be reattached i( ihe departrnent obtains an order tliat inheritance tax Is ewed.