Aff - Maxam, Nova_3/7/1972�
__
�
STATE OF INDIANA
COUNTY OF GIBSON SS:
�
-,.- - _
AFFIDAVIT OF DEATH AND HEIRSEiIP
_ - '. �`.
- `�,
�
� ��. , w
. i�,r
. ,6 ,
The undersigned, Nova Maxam, a resident of Francisco,
Gibson County, State of Indiana, and the surviving widow of
Carl J. Maxam, deceased, being first duly sworn on oath says:
1. That she is the surviving widow of Carl J. Maxam,
deceased, who died intestate, a resident of Gibson County,
Indiana, on January 14, 1972, and left surviving as his sole
and only heirs at law the following:
Imolee Hopkins (adult daughter).
Nova Maxam (widow) and
2. That said decedent; at the date of his demise, died
the owner of the following described real estate situate in
Gibson County, Indiana, towit:
A part of the southeast quarter of the northeast quarter of
section 22, township 2 south, range 10 west, and a, part of the east
half of the west half of the northeast quarter of said section 22,
township 2 south, range 10 west, together described as follows,
towit: beginning at the southeast corner of the northeast quarter
of said section 22 and running thence north to the center of the
old Francisco and Princeton gravel road; thence west along the
center of said gravel road to the west line of the east half of the
west half of the northeast quarter of said section 22; thence
south along said west line to the south line of the northeast
quarter of said section 22; thence east along the south line of said
quarter section to the point of beginning, containing 33 acres,
more or less;
Being the same real estate described in Deed Record No. 116
Page 212, Office of the Recorder o£ Gibson County, Indiana;
That this affiant states that to the best of her
knowledge and belief said decedent's estate will have a gross
of less than Sixty Thousand Dollars ($60,000.00), and will not
be subject to a Federal Estate.Tax - Form No. 706; that the
Indiana Inheritance Tax on decedent's_estate will be determined
in the Gibson Circuit Court under Estate Dkt. No. PR 72 -
3. That this affidavit is made for the purpose of
obtaining (there being no letters of administration taken out on the
estate of Carl J. Maxam, deceased), a transfer on the tax duplicate
Auditor of Gibson County, Indiana, from the individual name of
Carl J. Maxam to the name of "NOVa Maxam" and"Zmolee Hopkins"
adult-daughter.
Further this affiant sayeth not.
1�
�
-_ . -- ..
✓
�
Subscribed and sworn to before me this 7th day of
March, 1972. �
�0
- ./ o n W. Ballard, Notary Public
My Commission Expires:
November 7, 1972
TfiIS INSTRUMENT PREPARED BY: JOAN W. BALLARD, ATTORNEY