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AEFJDAVIT OF HEIRSHIP
HkCEIVED
Ll ' COLr:l C0U ToVed¢&4i:R/ vner No: ' 400
Becedent Name: Donald B. Anderson, Jr.
~. ,Lease Na~e: Reynard Unj,t t/1
STATE OF ~~ ) ...... "
) SS.
COUNTY OF ) 519p AG I 06
HENNEPZN
BEFORE ME, the undersigned authority, on this day personally appeared Gary R. Br&kke
well known to me to be a credible person, who being by me sworn to tell the truth, the whole truth,' and
nothing but the truth, made the following answers, in my presence, and having completed said answers,
he/~A~ subscribed them in my pre~en?, and swore the same were true to the best of his/~
knowledge and belief. ' ,. "' ....
State your name, age, and present address: Gary R. Brakke, 55, 5424 Shorelj,ne Drj,ve, lVbund IvN 55364
Were you acquainted with Donald B. Anderson, Jr. (the "Decedent") during his/her lifetime? Yes
How long did you know the Decedent? 15 years
Approximate date of his/her death: October 3, 2002
State whether or not the Decedent was ever married. Yes
(a) How many times? 2 1. KathrynSchilt-11/80. 2. Rebecca,lo
(b) Name of spouse or spouses and approximate date of marriage of each: Gregg 10/17/87.
(c) State whether spouse(s) are now alive or dead, and if dead, give approximate date of
death: Kathryn Schilt is dead; B0D approx. 11/85. Rebecca ,3o Greg9 Anderson j,s alive.
(d) Did any spouse leave any will within your knowledge? No
(e) Within your knowledge, was there any administration of any spouse's estate? No.
If so, where,
(0 If Decedent ~v/aAs divorced from any spouse, state name, date, and place of divorce:__
Did the Decedent leave any will within your knowledge? Yes
Was there.any 'administration of the Decedent's estate within your knowledge?
If so, give name and address of Executor or Administrator
NO, ·
and where such administration (is) (was) pending:
If yOu have answered that there was no administration of the Decedent's estate, please state to
the best of your knowledge what debts, if any, were left by the Decedent: None.
9. Give names of all Decedent's children, including adopted children, if any, and including any
children who are now dead,'and give the present addresses and ages of all living children:
If Deceased Social Security or
Name Address Age Date of Death Tax ID No.
Patrj.cJ.a Anderson, 3106 Priest Eane, rvbund r,,N 55364 19 years old. Lj,vj,ng. SSN: 520-19-7239
Aidan Ander'son, 3106 Prj,est Eane, ~ 1~ 55364 7 years old. Ej.v!ng. SSN: 474-29-2594
Wi,Iii. am .Anderson, 3106 Priest, Eane, Mound I'~ 55364 5 years ord. Living. SSN: 471-33-8794
NOTE: l.f no children are dead, Question#10 need NOT be answered. N/A
10. (a) If any children are. dead, state whether or not any such child left a will:
(b) Give the name and present address of an? surviving spouse of each such deceased
child:
(c) Give the names of all children, both liv ng and dead, of each such deceased child and
Name and
Child of
the p(esent addresses of all living children:
I I If Deceased
Address Age Date of Death
ISocial Security or
Tax ID No.
NOTE: If Decedent was suFvived by children or children of deceased children, Question t,el 1 need NOT
be ansWered. N/A
1 l: If the Decedent was survived by neither children nor their descendants, please answer the
following questions:
(a) Did the Decedent's father or mother survive him/her, and if so, give their names and
3resent addresses:
Name Address
ISocial Security No.
(b)
Name all brothers and sisters of the Decedent, both living and dead, stating the ages
and addresses of'those nowliving and the date of death of those now dead: .
Name Address ' Age Date of Death Social Security No.
(c)
If there are any' deceased brothers or sisters give the names, addresses and the social
security numbers of the surviving children of each:
Name I Address Age IChildof
rsocial Security No.
SubsCribed and sworn to before me, on .this day of
Y ' j~and for Hennepin "')
County, State of Minnesota
Apr i 1
/APPIAI~I Wary R. Brakk~
,2003
STATE OF
COUNTY OF HENNEPI'N~
Nancy Rehberger
CORROBORATING AFFIDAVIT
(TO BE EXECUTED BY PARTY OTHER THAN THE ABOVE AFFIANT)
MINNESOTA )
) SS.
)
., of lawful age, being first duly swOrn, on oalh states:
]-hat the affiant was well and personally acquainted wilh the Decedenl in his/her lifetime; that this affiant
has read the foregoing Affidavit of Heirship, knows the contents thereof, and Iha~_each and every.,.., . .
statemen.t therein contained is true to.the best of his/her knowledge and belief.. A~:<:~N{,.NT_~T /,~//L./i~,~,
I
Subscribed and sworn to before me, on this_ day of
S E A L ..---~ ,, .---'~'~
Notary Public in an for Hennep~n
County, State of
April 2~'
_, 20 03
NOTARY PUBLIC-MINNESOTA
MY COMMISSION EXPIRES 1..31-2005