Aff - Lashbrook, Bertha_6/8/1999�� •
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STATS OP INDIANA
COUNTY OP
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:xumenta 4 5�
Stale ot Irdiana
GIBSON COUNTV o//��
FIIED FOR RECORD T1i5 T�Y
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AFFIDAVIT OF SUAVIVOItSHIP �u.�, GJ�
Comea now�u�u�� �-��l�mn� . aho being duly
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ewom upoa der aath, alleges and i,v�--
I) That she ls the sutvlver • of �ERntA �C..Ls�.v/a.'caEwho dled on 7- .3�- 96�
2) That this Afflaat and decedent acqulred certala real eatate aa husband and wife, sttuated in
�a.) County,�State of�Indl�ns, moce patticularly described as follows:
SBB LBOAL
ATTACHflD
3) That upon the Death of the said �S� thla Afilart ba:ame the sole owrter of the totegoing
da�ribed real estate.
4) That from the tlme thie Aftiant and the daxdeat acquired the foregoing deacdbed real estete, they
I.�ld}�,�1� as j��w� tc�o:�-4S .pntilthedayoFtxrdeath.
5) This Affiant states that no inheritecme tax schedule has ban iiled nor is any tax due. Thls AFflant
further states that the estate of the eald waa not subjecCto Federal Estate
Tex.
6) Affiant further statea that the funere) bills, laat lilness aad other debta of the safd dxedent have
bee� paid.
7) That thfs Afftdavit Is made for the puipose of Inducing the Auditor of ��_
County, l�iana, to delete the name ofL�fy�4t�t, h.(�Sin „ l� from the tax rolle thereby
vesting title I
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�,��U i a. �-�DOL
[ore me, a Notary Public In a� for satd Counry and State, peraonally appeared
� / who ecknowledged the exaartton of the foregotng Afiidavit of Survivotehip,
aho, having beea duly sworn, states that eny reQresentattana thereta wntalned ere uue.
Witness my hand and Notarial Seal this � day of , 19 `�.
My Commission Bzpires: � ,
(prlated natne)
County of Restdtnce:
LISA G. STURM
This fmt�ument prepared by:Q�.bress•+2 .� Stete of Irdiane. WanderW�9h GwdY
' l.e.,+.AT�t\ Q My Canmission Ezpires 3-18-07
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�Lot Number Eleven (il) in Smith's Enlargement to the Town of Fort Branch,
Indiana. ,
Gibson County, Indiana.
More commonly known as: 605 S. Lincoln Street, Fort Branch, IN
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