Aff - Mayer, Leroy_10/4/1977A �,
AFFIDAVIT RELATING
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TO._ESTATE.OF LEROY F. MAYE�R, DECEASED
STATE OF INDIANA
SS: = �" ,KNOW.ALL MEN BY THESE PRESENTS:
COUNTY OF GIBSON �. _ , . , �
BEFORE ME, the undersigned authority, on this day personally
appeared Elfrieda F. Mayer�, known to me.ttd be a credible person, who,
being by me duly sworn, on her oath deposes and says: ,
"My name is Elfrieda F. Mayer. I reside in Haubstadt, Gibson
County, Indiana. I am the surviving spouse of Leroy F. Mayer, who died
on September 25, 1977, a.resident of Gibson County, Indiana, at the time
of his death; and I am the sole beneficiary under his Will which was
admitted to probate in Gibson County,. Zndiana on October:3, 1977." ._
"At the time of Leroy F. Mayer's death, he and I owned real
property situated in Gibson County, Indiana, and I am now the sole owner
of such real property by reason of his death. Such real property is
described briefly as-follows:
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Lofs number 169, 170 and,ten feet off of the East
side of.LOt number 171, in the original plan of the town'- .'
of Haubstadt, Gibson County, Indiana." '
"No Federal Estate Tax Return or Indiana Inheritance�Tax
Return were filed with the Internal Revenue Service or State of .
Indiana for the Estate of Leroy F. Mayer as the assets of Decedent''s'
Estate carried an insufficient value to cause Decedent's Estat'e to be
subject to any,.+Indiana Inheritance Tax or Federal Estate Tax:"
STATE OF INDIANA
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COUNTY OF GIBSON
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EL RIEDA F. MAYER, Individually and as ,!
the Surviving Spouse of Leroy F. Mayer,
Deceased.
Subscribed and sworn to before'me, a Notary Public in and
for said County and State, this � day of �e��,_/�,�� ,
1977.
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.`My Commission Expires:
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This Instrument Prepared by Dan L. Reeves, Attorney-at-Law.
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