Affidavit - Shoultz, Debra A_11/16/2015�A''
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SURVIVORSHIP AFFIDAVIT
Debra A Shoultz ("AffianY'), being first duly sworn on oaih states:
1. That ihe following is based upon Affiant's personal knowledge.
2. That Affiant is ihe owner of the following described real estate:
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The following described real estate in Gibson County, State of Indiana, to-wit:
Trect One:
A part of the Fraciional South Half of the Southeast Quarter of Seciion 31, 7ownship 1 South, :
Range 10 West in Patoka Township, Gibson Indiana and more particularly described as follows:�
The place of beginning may be found at an iron 211.30 feet east of the northwest corner of said
Fraction South Half quarter section, thence east 235.90 feet to the north right of way line of �
State Highway No. 65, thence south 42 degrees and 30 minutes west 292.57 feei to an iron
located opposite station 72 plus 80.93, thence north 10 degrees and 35 minutes west 209.13
feei to the place of beginning and containing 0.5600 acres.
Tract Two: '
A part of ihe Fraction South Haif of the Southeast Quarter of Section 31, Township i South,
Range 10 West, Patoka Township, Gibson County, Indiana, and more particularly described as '
follows:
The place of beginning may be found at an iron two hundred eleven and thirty hundredths ,
(211.30) feet east of the northwest corner of said Fractional South Half, quarter section; thence
south ten (10) degrees, thirty-five (35) minutes east, two hundred nine and thirteen hundredths
(209.13) feet to a 5/8 inch iron on the west right of way line of State Highway N65, opposite
station 72 plus 80.93; thence south forty-two (42) degrees thirty (30) minutes west, tweniy- �
seven and'forty-eight hundredths (27.45) feei to a 5/8 inch iron; thence north ten (10) degree>,
thirty-five (35) minutes west, two hundred twenty-eight and sixty-six hundredths (228.66) fee:
to a 5/8 inch iron on the north line of said fractional south half, quarter sectiorr, ,hence east !
DULY ENTERED FOR T,4XATION
�Sub'ect to (+nal acceptance (or tr nsfer /
day of �]��S
, • Auditor
`�! p Gibson County
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twenty-two and no hundredths (22.00) feet to the place of beginning and containing 0.1106
acres.
3. That Affiant and Chris W Shoultz were husband and wife at the time they acquired title as tenants
by the entireties to said real estate by deed dated 10/31/2003 and recorded 11/03/2003
Instrument 200300009848 the Office of the Recorder of Gibson Couniy, Indiana.
4. That the marital relationship which existed between this Affiant and Chris W Shoultz continued
unbroken from the time ihey acquired title to said real estate untii the death of said spouse on
06/27/2015, at which time this Affiant acquired title m said real estate as surviving tenant by the
entireties.
5. That all debts, funeral expenses, and expenses of the last illness of said decedenY have been fully
paid and satisfied.
6. That the gross value of the estate of said decedent, including all jointly held property, all gifts made
in contemplation of death, or made within the three years preceding said death, together with the
value of all investments in joint properties and tenants by the entireties, including the real estate
above described, plus the proceeds of all insurance on the life of said decedent, was an amount
which was not subject to a Federal Estate Tax.
7. That this affidavit is being made for the purpose of establishing title in the above described real
estate in the name of the Affiant.
IN WITNE55 WHEREOF, The Affiant has executed this Survivorship Affidavit this a- � day of
�C�obe r , 20� j
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Debra A Shoultz
Before me, a Notary Public, in and for said County and State, personally appeared
�Zbrc Shoul�'� , who acknowledged the execution of the foregoing Survivorship Affidavit on
the' � date of�}�s , 20i5.
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SHAWNA WITSHOAK Notary Public
NOTARY PUBUC
SEAL 1/
STATE OF INDIANA • CAUMY OF KNOX � W(�D. C.�, }S�ll(X !�
MIS I N PIR A `
Printed Name
My Commission Expires: Residing in�
�' a�— a' �� f'l VIOi� County, lndiana
This instrument was prepared by: Debra A Shoultz
Mail Tax Statement to: 1752 N Old Petersburg Rd, Princeton, IN 47670
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X �D� , I affirm, under penalties for perjury, that I have taken reasonable wre to ;
redact each Social Security number in this document, unless required by law.
Relum Tu:
Soulhwesl Financial Services, LTD.
PO Boz 300
Cincinna[i, OH 45273-8043
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