Aff - Sloan, Clarabell_3/15/2006DULY EN7ERED �Gk 7nX TION
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STATE OF L\TDIANA
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COU�'TY OF GIBSON
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DISCLAIAIER OF JOINTLY HELD INTEREST IN REAL ESTATE
The imdersigned, in his leeal capacity as personal represzntative of the Estate of Laura Lee
�-icGeehan, bein� duly swom upon his oath states as follo«�s:
Thai he is the duly qualified personaf rzpresentati��e of the estate of Laura Lee VlcGezhan,
��liich estate is being administered in the Gibson Circuit Court under Cause No. 26C01-0�09-ES-OOS�.
2. That the decedent, Clarabell Sloan, age S2, died intestate on September 6, 200�, a resident
of Gibson County, Indiana, but no estate proceedin� has been opened as the decedent owned no propert��
�ahich cannoi be passed outside of probate.
3. That prior to the demise of Clarabell Sloan, she had established o�rnership of real estate in
Gibson County, Indiana, as joint tenants with rights of sun�ivorship beh�een herself, Roy ��Ieh�in Sloan,
Laura Lee \-icGeehan, and Daniel �4e1� in Sloan and that as a resiilt of the death of Clarabell Sloan; Laura
Lee �4cGeehan, Roy vleh�in Sloan, and Daniel b4eh�in Sloan will become vested �� ith ownership in the real
estate unless the interest of Laura Lee ��IcGeehan is disclaimed. This real propeRy is commonly l:no�vn as
212 To�� n Hall Street, Patoka, Indiana 47666, and more specifically described as follo���s:
A part of Lot \'o. 12 in S��SITHL.�\'D DI\'ISION of the to«n of Patoka, described as
follo��'s:
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Be�inning at the south�vest comer of Lot No. 10 in said Division, and run thence south, 6
deerees west, 14� feet, more or less, to the south line of said Lot No. 12; thence n!n in a
westerly direction alon� said south line to the southwest comer thereof, thence nm in a
northedy direction along the ���est line of said Lot to the nortfivest corner thereof; thence run
in an easterly direction along the north line of said Loi to the place of be�inninQ;
E�CEPT�'G therefrom the right-of-�vay of the C. R E.I. (now L. R\.) Railroad; and
Subject that portion thzreof adjacent to the east line of the tract hereinabove described platted
or used as a roadway.
,�.L,SO, part of Lot li in Smithland Addition to the to���n of Patoka, being the same land
com�eved by Tas Deed recorded in Tax Title Dzed Record 3, at pa�e �OS.
4. That Laura Lee \4cGeehan has no claim to this real estatz and did not fumish any
consideration for the funds that «�ere used to purchase the subject real estate.
5. That Laura Lee ��IcGeehan has esercised no authority or control o� er the subject real estate.
6. That the property set out abo�e should transfer as though Laura Lee �4cGeehan predeceased
Clarabell Sloan and pass to the otherjoint owners.
7. That the undzrsi�ed has revie��ed the ramifications of this poteniial inheritancz that ���ould
come to the Estate of Laura Lee V1cGeehan, and has determined that it is in the best interest of the Estate of
Laiva Lee A-ScGeehan, and her beneficiaries, if this potential inheritance is disclaimed.
S. That the undersigned has been fuRher advised that pursuant to the pro��isions of I.C. § 32-
17.5 et. seq., he has a ri�ht to disdaim or refuse to accept the distributions to ���hich the Estate of Laura Lee
�ScGeehan, is entitled and ���hich ���ould vest in Laura Lee McGeehan, and that in the eaent of such
disclaimer, the assets of Clarabell Sloan «�ill be distributed as if Laura Lee �•tcGezhan predeceased Clarabell
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s�oan.
9. The undersi�ed having full knowlzdge of the above, hereby irre��ocably disclaims the
interest to «�hich Laura Lee �-ScGeehan or her estate would bz entitled in the real estate set out abo��e located
at 212 Town Hall Street, Patoka, Indiana.
10. It is the intzntion of the undersigned that this Disclaimer constitute a qualified disclaimer as
defined in Section 2�-15(c)(3) of the Intemal Re��enue Codz as amendzd in the correspondin� provisions of
any subsequznt federal tax la«• and also constimtes a qualified disclaimer under the appropriate provisions of
I.C. � 32-17.� et. seq. and fiilfills the disdaimer procedure established under I.C. § 32-175-3-3 and LC. � 32-
17.�-7 et. seq.
I\' ��'IT\TESS �VHEREOF, the undersigned has here under set his hand and seal this IC�`�`day of
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Roq i� lo�rr, ersonal Representative of the
Estate of Laura Lee �4cGeehan
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Subscribed and swom to before me this %O day of � �-��
��fy Commission Espires: (' %/cr.����n���
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07-06-09 Daniel L. Sie�vers, Notar�� Public
residin� in ICnox Co�mty, Indiana
1G�ESTATFR?i66Sla�n—Disciaimer o� Ineerest —Real Estste
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Prescribed by the
State Board of Accounts
(2005)
Declaration
County Form 170
This form is to be signed by the preparer of a clocument and recorded with each docu-
ment in accordance �vith IC 36-2-7.5-5 (a).
I, the undersigned preparer of the attached document, in accordance �vith IC 36-2-7.5,
do hereby affirm under the penalties of perjury:
1. I have revie�ved the attached document for the purpose of identifying and, to
the extent permitted b}� la���, redacting all Social Securit}� numbers;
2. I have redacted, to the extent permitted by la�v, each Social Securit}� number
in the attached document.
I, the undersigned, affirm under the penalties of perjury, that the foregoing declarations
are true.
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Signature of Declarant
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Prin[ed 1�'ame of Dedarant