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106a4896 <br />RECORDED AS PRESENTED ON <br />06/13/2006 01:40:22PK <br />TERRI J. REMAKE <br />ST. JOSEPH RECORDER <br />OUNTY <br />REC FEE: $13.00 <br />PAGES: 2 <br />State Form 37225R2 <br />R 11/88 <br />STATE OF COLORADO ) Project STP-9971 053 <br />) SS: Parcel 13 <br />V7 sr or �rr.�nfa.c ror > Code NZA <br />AFFIDAVIT OF SURVIVING SPOUSE <br />I, Patricia A. Bassett , the undersigned affiant, being duly sworn upon my oath, <br />hereby say that I am_ years of age and that I am the owner of the following described real <br />estate located in St. Joseph County, State of Indiana, to wit: <br />See attached Exhibit "A" <br />Afl-iant further says that she is the surviving wife of J4mes M Bassett , who died <br />intestate in the County of , State of aw— , on June l I , 200, <br />that this affpsant�a,,nd the said de edent lived together continuously as husband and wife from the <br />date of �a�A-y / 7 ,19�, until the date of decedent's death and were so living <br />together on said date, that no administration was had upon the Estate of the said decedent, but <br />that all funeral expenses, expenses of the last illness and debts of every kind and character were <br />fully paid, that no Indiana Inheritance Taxes or Federal Estate Taxes or any other taxes which <br />might have been assessed against such estate are due or payable on said estate or the assets <br />distributed therefrom. <br />The affsant makes this affidavit for the purpose of inducing the City of South Bend, State <br />of Indiana to accept a deed from the grantor thereon conveying all or part of the afore -described <br />real estate to the City of South Bend, State of Indiana, <br />(Affiant's Signature) <br />Patricia A. Bassett <br />(Affzant's Printed Name) <br />Before me, a Notary Public in and for said County and State personally appeared <br />_ Patricia A. Basselt who acknowledged the truth of the statements in the foregoing affidavit <br />� on this !b day of ILLU )DW- , 2005. <br />u <br />NOTARY PUBLIC <br />STATE Of COLORADO <br />r . DONS ''Pole 222iNM <br />My Commission expires <br />My County of residence is 0�— <br />This instrument was prepared by BQy A B Wkirk <br />Notary PLkic (S )ture <br />-Mtk" �-&U,,_ <br />Notary Public (Printed Name) <br />