HomeMy WebLinkAbout887833STATE OF,.
COUNTY OF
AFFIDAVrr o~rRSHIP OF I BM
~ Donald B. Anderson, Jr.
' Deceased "'
,~,' RECEIVED
MINNESOTA. l ss. ~'~R' ' "':' ' ? 0 ~ OOU'bII'V ~,L,_,,Kc ~,
HENNEPIN j BOOK-- PAGE LlblCOLt'!
for
Gary R. Brakke . ~'~ 0 -~ ~')p~'~&ul age being first duly sworn, on oath deposes .nd ~ys:
~hat affiant was personally and well. acquainted ~i t~e above named d~edeni during the la~re~s;~n~dtime' ha~ng NfioWn deceased
1
years. .. ~f. ~[7 ~',~ ~',~ [}' =~, ~ ['.~ ': ': ? '''h ~ ~ ,:
Carver County, State of
Decedent died at
gu or about th~ 3rd day of October )i~ 2002 , being 52
Mound, Minnesota . at the timeof'death.
Minnesota
years of age, and a resident of
That the following statement~ and answers to the following questions are based upon the personal knowledge of affiant and are
true and correct:
1. Did decedent leave a will? Yes If so, has the will been admitted to probate N0 - Give name of County and State in which
such proceedings are pending, and name and address of executor.
(If decedent left~a Will, please a~cach q.qertltied c,opy (If same, together xvith a copy of the. ordelr of court admitting it to probate, and letters
testamentary.) xNote: unoer minnesota law, the probate assets involved in Donald B.
Anderson, Jr.'s estate do not merit pro. bate therefore will is not attached.
2. If decedent left no will, have administration proceedings been st;.rted?__ N/A If so, give the name of the county and state in which
said administration Proceedings are pending and name and address of' administrator
Have ancillary pr~?bta~te proceedings been had on decedent's estate?
If so, When? I~/a. Where?
4. If no aflministration proceedings have been started, are tb~ere any plans to have the estate administered?
No
5. Did decedent leave any unpaid taxes, including federal estate or state inheritance taxes or other debts?
possibl~, [he amount of such taxes or other debts, to whom owing, and whether they have since been paid.
NO If so, give as nearly as
6. Was decedent' surety on any bond or guarantor of any other berson's indebtedness at time.of death?.
No
If so, give details as to
principM debtor, amount, etc.
7, Were there any suits pending or judgments rendered against decedent at time of death?
involved and parties. '.
No
H so, state briefly the nature, amount
8. Marital' Status'of Decedent at Time of Death (mai-tied, single, divorced, widow, widower)
married
married, ~ive the following information for each marriage: (Lls't names in order of marriage)
Date of Death Was the~'e a property settlement?
Living/Dead
Divorced
If "Yes"~attach copy.
Name of SpouSe(.aSl-~h~ Date of Marriage. or Divorce
Kathryn Schilt' 11/1980 Dead 11/1'985 N/A
Rebecca Jo Gregg 10/17/87 [tying
Anderson
children by )ouse, or adopted any children, give the following information:
· ] 'D~te of . Living/Dead Date of Death By Which Spouse
Name of ChUd/.~SN# Address- ·
Birth
Patricia Andefson17-26-8:.3106 Pri.est lane Living Kathryn Schilt
520-19-7239 .Mound MN 55364
Aidan Anderson 3-2-95 3106 Priest Cane [ivinq Rebecca Jo Gre_q
474-2~2594 Mound MN 55364 Anderson
William Anderson 6-6-97 3106 Priest L:ane [ivinq Rebecca Jo Greg
471_.33_8794 .Mound MN 55364 . Anderson
Form 540 3-77 ' '
11. If a deceased child left descendents, give the following information:
Date of Address Living/Dead Date of Death
Name of Child Birth
N/A
Name of deceased child
Name of deceased child
12. If decedent left no 'children or descendents of deceased children, then please furnish the following Jrdorraation:
a. Give names of parents of decedent;
Name Address Living/Dead Date of Death
Father
Mother
b. Give names of brothers and sisters of decedent:
Name Relation Address Living~ead Date of Death '
Sarah Anderson Sibling .25 Sycamore l'iving
Sprinqfield It
)
c. Give names of children of deceased brother or sister:
Name of Child Child of Date of Birth Address Livir/g/Dead~
N/^
13. If decedent left no heirs covered by item 12 above, then attach a full and complete a~fidavit of heirship of s~id decedent in narrative form.
14. Give location or description of homestead of decedent, as of date of death: 3106 Pr/est Lane, Mollnd MN 55364.
15. As to each tract of land or interest in land ~wned I~ ' the decedent at the time of his death which concerns this company, give the following infor~ati0n which
will be used primarily for the purpoee of determinin wh'ether property was separate or community: (If space provided ks insufficient, attach exhibit giving same
information as to each tract).
State How Acquired If acquired by Purchase, were
· (Gift, Purchase. funds used those of decedent
c Date From Whom?
Description Acquired Inheritance or only or community property
Under a Will) fun~ with spouse?
C.I.G. FED 1-10/DAK/ :Donald B.'Anderson Inheritance Separate ~
[inco.ln County, WY
Property ID //18830600
16. Here briefly state facts and circumstances (~uch as being a relative, a close friend, or attorney or agent for, decedent) which will :show basis
and source of in.formation given_above.
I havebeen Donald B. Anderson, Jr.'s Certified Public Accountant and friend
for 15 years.
Subscribed and sworn to before me this
1-31-2005
My commission e~pires'
11th
day of
SUPPORTING AFFIDAVIT
STATE OF. MINNESOTA ·
COUNTY OF HENNEPIN ss.
Nancy. Reh'berger
That
that ~h~
Gary
R.
has read the,.above affidavit by
¢~,.....,...~¥~' ROGER REED
Z ~l NOTARY PUBLIC'MINNESOTA
~'~ MY COMMISSION EXPIRES 1~1-2~5
Address
F~F-~ry ~"x~ . ~ 2003
~' ~ - · ,'. ~ NOtary Pub'hc
:;'~: ~.~ :~:~ PAUL L. POND
~ ~.~ 2] ,NOTARY PUBLIC-MINNESOTA'
MY COMMiSSiON ~PI~ES
, of lawful age, being first duly swo. rn, on oath states:
R B~akke w~ personally and well acquainted with ~c)na ~ f~ R: ~ersop., 3,r'/luring ,il, i ~ lifetime:
Subscribed and sworn to before me this
1-31-2005
My commission expires :.
11 th day o~
Brakke and that th~ facts stated therein are true and correct.
Febr,lary ///~ ./ (/~~......-'""~'~ I.~.~, 2003
Notary P~I~ </