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DAGUE & BUCK. Up. ATIORNEYS
TElEPHONE MEMO
Date: _ _ _ _ _ __
Client: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Time:,_ _ _ _,a.m.!p.m. Case Name:_ _ _ _ _ _ _ _ _ _ _ _ _ _ __
TolFromIRetumTo: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
NotH: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(Circle One)
LCD
MLB
LCD/CorrespXlMemo
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DAGUE & BUCK, LLP - PAYMENT FORM
FILENAME
-------
----------
ATTORNEY
LCD
MLB
CHECK / MONEY ORDER I CASH
#
AMOUNT $
--
-----------
---------~--.,--
DATE
TO FIRM ACCOUNT _____ _
ATTORNEY FEES _ _ _
FILING FEES
TO TRUST ACCOUNT ______ _
RETAINER _ _ _ _ _ _
FILING FEES _ _
COLLECTION _ __
SUBROGATION _ __
REMITTER _ _ _ _ _ _ _ __
NOTES _ _ _ __
--
-------------------
-------------------
--------
---------
ATTACH PAYMENT
DOCUMENTS TO BE FILED WITH COURT - COPIES NEEDED
Case Name
Pleading Name:
-----
- ------------------------- - - -
- - - - - - - - - ----------------------
----- -----
-
ongmal
file marked
to court
1 copy
for our ftle
stays here when you go to Justice Center
_ _ _ coples
ftle marked
to court
_____ coples
llie marked
back to our off,ce
__________ coples
fiJe marked
with FYI stamp, to Attorney
____.__,._. ________ .______ s
box 10 Court Administrator's Office (and complete back of 1 copy that
comes back to our office)
_____ TOTAL COPIES ]"EEDED (plus original)
Order Name:
ongmal
clo !lot file mark
to court
1 copy
for our file
stays here when you go to Justlce Center
_________ caples
do not tile mark
to cou11, write last name of in upper right hand corner of ______ _ _______ copies
________ copies
flle marked
back to our office
___ TOTAL CUPIES"EEDED (plus onginal)
LCD & tvJLB
~/30!20D
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PHOTOCOPY REQUEST
CASE
DATE,____________
_ _make_ _white copy(ies); send copy(ies) to, _ _ _ _ _ _ _ _ _ _ ___
___no need to make copy(ies); send one to_ _ _ _ _ _ _ _ _ _ _ _ __
___fill in back stamped area of original for our file
_ _make,_ _yellow copy(ies) for our case file
___make
yellow copy(ies) for invoice file
___oili~~~--~----------~~~~------LCDlMisc.4/a:PhotocopyRequest.wps
LCD MLB
~1HrL1:.:J
DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd.
Suite 2
Muncie, Indiana 47304
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DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd.
Suite 2
Muncie, Indiana 47304
DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd.
Suite 2
Muncie, Indiana 47304
IN THE DELAWARE COUNTY CIRCUIT COURT
)
IN THE MATTER OF THE ESTATE
OF _ _ _-===-:-='
DECEASED
Cause Number: 18CO_ _ _ __
)
)
(To be supplied by Clerk when case isfiled)
APPEARANCE BY ATTORNEY IN CIVIL CASE
Party Classification:
Initiating
Responding _ _
X
Intervening _ _
I. The undersigned attorney and all attorneys listed on this form now appear in this case for the
following party member(s):
, Deceased
2. Applicable attorney information for service as required by Trial Rule 5(B)(2) and for case
information as required by Trial Rules 3.1 and 77(B) is as follows:
Linda Clark Dague
Attorney No.: # 4744-18
DAGUE & BUCK, LLP
1100 S. Martin Luther King, Jr., Blvd., Suite 2
Muncie, Indiana 47304
3. There are other party members: Yes _ _
Phone: 765-289-4505
FAX: 765-289-4507
Computer Address: lcdague@iquest.net
No~
4. Iffirst initiating party filing this case, the Clerk is requested to assign this case the following Case
Type under Administrative Rule 8(b)(3): Estate Unsupervised
5. I will accept service by FAX at the above noted number: Yes
J_
No
6. This case involves support issues. Yes _ _ No J _
7. There are related cases: Yes
No
X
8. This form has been served on all other parties. Certificate of Service is attached:
Yes
No_ N/A
9. Additional information required by local rule: None
Dated this _ _ _ day of _ _ _ _" 2003.
Linda Clark Dague, Attorney #4744-18
LCDllgalProbatelV1
.appear
)
) SS:
COUNTY OF DELAWARE )
IN THE DELA WARE COUNTY COURTS
IN THE MATIER OF THE EST ATE
CAUSE NUMBER: 18CO_ _ _ __
ST ATE OF INDIANA
2003 TERM
OF _ _ _~~~~
DECEASED.
PETITION FOR PROBATE OF WILL
AND ISSUANCE OF LETTERS WITHOUT COURT SUPERVISON
_ _ _ _ _ _ _., Petitioner, being first duly sworn upon his/her oath, says:
I. Decedent died on or about the _ _ _ _ _ (#) day of _ _ _ _, 2003, aged
_ _ _ _ _--'(#) years, and at the time ofhislher death was domiciled in Delaware County,
Indiana, and owned property in Delaware County, Indiana.
2.
Decedent is believed to have died testate, leaving a Last Will and Testament dated
_ _ _ _ _ _ _ _", and said Will is submitted to the court herewith. After making said Will, the
marital status of the decedent was not changed by divorce nor annulment.
3.
The name, age, relationship to such decedent and place of residence of each known
legatee and devisee of said decedent's estate is:
Name
Relationship
Age
4.
Residence
The probable value of decedent's property is:
Real property
Personal property
$
$
undetermined
undetermined
The probable value of the annual rents, issues and profits of all property of said estate is: undetermined.
5.
The total debts and taxes owing by or to be payable from the estate probably will not
exceed: $ undetennined; therefore said estate is believed to be solvent.
6. The name and place of residence or business address of the person designated as
personal representative of said Will is: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
if,Hti&\.~SliltItJ
7. The name and business address of the attorney who will represent the personal
representative of said decedent's estate is Linda Clark Dague, Attorney #4744-18, DAGUE & BUCK,
LLP; 1100 South Martin Luther King, Jr., Blvd., Suite 2; Muncie, Indiana 47304.
8. The petitioner is an interested person for the reason that he/she is a _ _ _ _ __
of the decedent and is named as Personal Representative in decedent's Will.
9. That the foregoing statements are true and complete so far as known to petitioner
or so far with reasonable diligence could be ascertained by petitioner.
WHEREFORE, the petitioner prays the court for an order (a) probating the decedent's
Will mentioned above, (b) appointing the personal representative ofthe decedent's estate, (c) directing
the issuance of Letters Testamentary evidencing such appointment, upon proper qualification in the
manner provided by law, and (d) authorizing such personal representative to administer said estate
without court supervision.
I swear or affirm under the penalties for perjury in the State of
Indiana, that the foregoing representations are true this
day of _ _ _ _ _ _, 2003.
_ _ _ _ _ _ _ _ _, Petitioner
Prepared by:
Linda Clark Dague, Attorney #4 744-18
DAGUE & BUCK
1100 S. Martin Luther King, Jr., Blvd., Suite 2
Muncie, Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE
OF
, DECEASED
LCDllgalProbatel
v,
petition
STATE OF INDIANA
)
) SS:
COUNTY OF DELA WARE )
IN THE MATTER OF THE ESTATE
OF ______~~~==
DECEASED
IN THE DELAWARE COUNTY COURTS
2003 TERM
CAUSE NUMBER: l8CO,_________
ORDER ADMITfING WILL TO PROBATE
AND GRANTING LETTERS TESTAMENTARY
WITHOUT COURT SUPERVISION
Comes now _ _ _ _ _ _ _ and produces in open court and submits to
the court instruments in writing purporting to be the Last Will and Testament of
_ _ _ _ _ _ _ _, deceased, and a Petition for Probate thereof and Issuance of Letters
thereon, for administration without court supervision, together with an affidavit of death of
said decedent.
That on the ______ (#) day of ________" 19_ or 20-, decedent
and the witness to his/her purported Will self-proved said Will by executing an
acknowledgment and verification of said Will and that said acknowledgment and
verification were executed in all respects according to the law.
Said instrument, petition, affidavit of death, written testimony!
acknowledgment and verification are now submitted to the court, and the court, having
examined the same, and having heard evidence and being duly advised, now finds that:
1. Said decedent died on or about the _______ (#) day of _ _ _ _ _.
2003, and at the time of death (a) was domiciled in Delaware County, Indiana, and (b) left
property in Delaware County, Indiana.
2. The estate is solvent/insolvent.
Ofdu-
3. That _ _ _ _ _ _ _ is qualified to administer the estate as personal
representative without court supervision.
5. Said written instrument purporting to be said decedent's Last Will and
Testament was duly executed in all respects according to law, has been self-proved/has
been proved by the examination under oath of _ _ _ _ _ _ _" one of the subscribing
witnesses thereto, is the Last Will and Testament of said decedent, and is entitled to be
admitted to probate in said county.
6. Letters should be issued as indicated and requested in said petition. Said
Will, petition, affidavit of death and written testimony/ acknowledgment and verification
read as follows:
(H.I.)
IT IS THEREFORE ORDERED, ADJUDGED, AND DECREED BY THE
COURT:
1. That said written instrument purporting to be the Last Will and
Testament of said decedent be and it is hereby admitted to probate and record as such.
2. The decedent was never married. The personal representative is a
_ _ _ _ _ _ _ [son, daughter, friend, etc.] ofthe said decedent, is domiciled in
_ _ _ _ _ _ County, Indiana, and the personal representative shall be permitted to
serve without posting a fiduciary bond.
3. Personal representative, _ _ _ _ _ _, is authorized to administer
the estate without court supervision.
r
4. The Clerk be and she is hereby directed to execute and issue Letters
Testamentary to _ _ _ _ _ _ _ _ _ upon proper qualification as provided by law.
Said personal representative does now qualifY by filing acceptance and
oath, and Letters as prayed for and designated above are now issued. Such acceptance,
oath, and Letters read as follows:
(H.I.)
Signed in Open Court, this _ _ _ _ day of _ _ _ _" 2003.
,JUDGE
=-D=EL=-A"'-:W::C:-:-A=-RE=-=C:-::CO-::-:UN=-=T=-=Y:-:C=IR=-C=uro-::'T COURT
Linda Clark Dague, Attorney #4 744-18
DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd., Suite 2
Muncie. Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE
OF
, DECEASED
lCDllgalProbateIV/_ _ _ _ _ order admit
r
)
) SS:
COUNTY OF DELA WARE )
IN THE DELA WARE COUNTY COURTS
IN THE MATTER OF THE ESTATE
CAUSE NUMBER: 18CO_ _ __
STATE OF INDIANA
2003 TERM
OF _ _ _ _ _~~~~,
DECEASED.
AFFIDAVIT OF DEATH
Comes now _ _ _ _ _ _ , [friend, son, daughter, etc.] of
_ _ _ _ _ _ _ _ , deceased, being duly sworn upon his/her oath, and says:
That _ _ _ _ _ died on or about the _ _ _ _ _ (#) day of
_ _ _, 200_, and at the time of such death was a resident of _ _ _ _ _ _,
Muncie, Indiana, in Delaware County, Indiana.
I swear or affrrm under the penalties for perjury in the State ofIndiana,
that the foregoing representations are true this _ _ _ day of _ _ _ _ , 2003.
PERSONAL REPRESENTATIVE
Prepared by:
Linda Clark Dague, Attorney #4744-18
DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd., Suite 2
Muncie. Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE
OF
,DECEASED
LCDllgalProbateIV'_ _ _ ,.Affidavit of Death
AU=fdtbM-of ~­
~~
STATE OF INDIANA
)
) SS:
COUNTY OF DELA WARE )
IN THE MATTER OF THE ESTATE
OF ______~~~==~
DECEASED.
IN THE DELAWARE COUNTY COURTS
2003 TERM
CAUSE NUMBER: 18CO___________
ACCEPTANCE AND OATH
______________., being fIrst duly sworn upon hislher oath, says that he/she
accepts hislher appointment in said cause as personal representative of the estate of
____________, deceased, and that he/she will faithfully discharge the duties ofhislher trust
according to the law.
Dated at Muncie, Indiana, this ______ day of ________, 2003.
PERSONAL REPRESENTATIVE
SUBSCRIBED and sworn to before me this _____ day of _______, 2003.
Linda Clark Dague
(Printed Name)
Notary Public,
A resident of Deiaware County
My Commission Expires:
Februarv 12. 2008
Prepared by:
Linda Clark Dague, Attorney #4744-18
. DAGUE & BUCK
I 100 South Martin Luther King Blvd., Suite 2
Muncie, Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE
OF
, DECEASED
LCDllgaIProbateIV/_ _ _ _ .oath
r
CAUSE NUMBER: 18CO_ _ _ __
LETTERS TESTAMENTARY
I, Karen D. Wenger, Clerk of the Circuit Court No.5 of the County of Delaware
in the State ofindiana, do hereby certify that Letters Testamentary, of the estate of
_ _ _ _ _ _ _, late of Delaware County, deceased, are granted to _ _ _ _ __
and the said
having qualified as Personal Representative, is duly
authorized to take upon hirnselfi'herselfthe administration of such estate, according to
law.
WITNESS my hand and the seal of said Court, this
_ _ day of
, 2003
Clerk of the Circuit Courts of Delaware County
LCDllgaIProbateIV'_ _ _ ,.Ietters testamentary
r
)
) SS:
COUNTY OF DELA WARE )
IN THE DELA WARE COUNTY COURTS
IN THE MATTER OF THE ESTATE
OF _ _ _ _ __
DECEASED
CAUSE NUMBER: 18CO_ _ _ __
STATE OF INDIANA
2003 TERM
NOTICE OF UNSUPERVISED ADMINISTRATION
In the Circuit Court No.5 of Delaware County, Indiana.
In the Matter of the Estate of _ _ _ _ _ _" Deceased.
Notice is hereby given that _ _ _ _ _ _ was, on the _ _ _ day of
___,,2003, appointed personal representative of the estate of _ _ _ _ _ _,
deceased, who died on the _ _ _ _ (#) day of _ _ _., 200_, and was authorized to
administer said estate without court supervision.
All persons who have claims against this estate, whether or not now due,
must file the claim in the office of the clerk of this court within three (3) months from the
date of the first publication of this notice, or within nine (9) months after the decedent's
death, whichever is earlier, or the claims will be forever barred.
Dated at Muncie, Indiana, this _ _ _ day of _ _ _ _ _" 2003.
KAREN D. WENGER, CLERK
DELAWARE COUNTY CIRCUIT COURT NO.
Linda Clark Dague, Attorney #4744-18
DAGUE & BUCK. LLP
1100 South Martin Luther King Blvd., Suite 2
Muncie, Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE
,DECEASED
OF
LCDllgatProbateIV/_ _ _ ,notice
r
)
) SS:
COUNTY OF DELAWARE )
IN THE DELAWARE COUNTY COURTS
IN THE MATTER OF THE ESTATE
OF _________________ ,
DECEASED
CAUSE NUMBER: I8CO_ __
STATE OF INDIANA
2003 TERM
CLERK'S CERTIFICATE OF MAILING NOTICE
I, Karen D. Wenger, Clerk of the Delaware County Circuit Court No.5 of
Delaware County, Indiana, do hereby certify that on the _______ day of _____.
2003, a notice, a copy of which is hereto attached, forwarded was by me by ordinary mail
addressed to each heir, devisee, ward and interested person at their respective address as
set forth in the petition for probate of will and issuance ofletters, heretofore filed herein
by the personal representative of said estate.
Witness my hand and seal of said court this _______ day of ___ , 2003.
KAREN D. WENGER, CLERK
DELAWARE CIRCUIT COURT 5
Prepared by:
Linda Clark Dague
Attorney #4744-18
DAGUE & BUCK
1100 South Martin Luther King, Jr., Blvd., Suite 2
Muncie. Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE
OF
,DECEASED
LcongalProbatel v,_ _ _ _ .Cenificate
)
) SS:
COUNTY OF DELAWARE )
IN THE DELAWARE COUNTY COURTS
IN THE MATTER OF THE ESTATE
OF _______________
DECEASED
CAUSE NUMBER: I8CO,_ _ _ __
STATE OF INDIANA
2003 TERM
NOTICE OF UNSUPERVISED ADMINISTRATION
TO BE MAILED TO A DISTRIBUTEE
Notice is given that _____________ was, on the _______ day of
________,2003, appointed personal representative of the estate of _____________
who died on _______________, leaving a Will. The estate will be administered
without court supervision.
As an heir, devisee, or legatee of the estate (a "distributee"), you are
advised of the following information:
1. The personal representative has the authority to take
actions concerning the estate without first consulting you.
2. The personal representative may be serving without
posting a bond with the court. You have the right to petition the court
to set a bond for your protection.
3. The personal representative will not obtain court
approval of any action, including the amount of attorney's or personal
representative's fees.
4. Within two (2) months after the appointment of the
personal representative, the personal representative
must prepare an inventory of the estate's assets. You have the right to
request and receive a copy of this inventory from the personal
representative.
5. The personal representative is required to furnish you
with a copy of the closing statement that will be filed with the
court, and. if your interests are affected, with a full account in writing
of the administration of the estate.
~tt.(~"""'~ •
t.sl~
r
6. You must file an objection to the closing statement within three (3)
months after the closing statement is filed with the court if you want
the court to consider your objection.
7. Ifan objection to the closing statement is not fIled with the court
within three (3) months after the filing of the closing statement, the
estate is closed and the court does not have a duty to audit or make
an inquiry.
IF, AT ANY TIME BEFORE THE ESTATE IS CLOSED, YOU HAVE REASON
TO BELIEVE THAT THE ADMINISTRATION OF THE ESTATE SHOULD BE
SUPERVISED BY THE COURT, YOU HAVE THE RIGHT TO PETITION THE
COURT FOR SUPERVISED ADMINISTRATION, IF YOU DO NOT
UNDERSTAND THIS NOTICE, YOU SHOULD ASK YOUR ATTORNEY TO
EXPLAIN IT TO YOU,
The personal representative's name, address and telephone number are
:-:::-:-~-=---:-=----'---:7c-::::-:-:-:-:,-.. The attorney for the personal representative
is Linda Clark Dague, Attorney #4744-18, DAGUE & BUCK, LLP, whose address is
1100 South Martin Luther King, Jr., Boulevard, Suite 2, Muncie, IN 47304, and
telephone number is (765) 289-4505.
Dated at Muncie, Indiana, this _ _ _ day of _ _ _ _ _ _., 2003.
KAREN D. WENGER. CLERK
DELAWARE CIRCUIT COURT 5
Prepared by:
Linda Clark Dague
Attorney #4744-18
DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd., Suite 2
Muncie, Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE
OF
,DECEASED
LCDllgalProbateIV/_ _ _ _ .notice distributee
STATE OF INDIANA
)
) SS:
COUNTY OF DELAWARE )
IN THE DELA WARE COUNTY COURTS
IN THE MATTER OF THE ESTATE
OF _ _ _ _ _
DECEASED.
CAUSE NUMBER: \SCO._ _ _ _ __
--==
2003 TERM
CONSENT FOR UNSUPERVISED ADMINISTRATION
OF DECEDENT'S ESTATE
Comes now _ _ _ _ _ _., an heir in the estate of _ _ _ _ _ _ _-'
and states that he/she is an adult over the age of eighteen (IS) years and has knowledge of
the petition of _ _ _ _ _ _ _ to qualify and serve as personal representative of the
estate of _ _ _ _ __
That the affiant herein further states that he/she joins in said
petition, and that he/she consents to the administration of the estate without court
supervision, and agrees to the personal representative serving without bond. The affiant
further states that he/she understands that the court will not be overseeing the activities of
the personal representative of the estate in any way, unless notified by the affiant or
another interested party to revoke the order of the unsupervised administration and require
the personal representative to proceed according to supervised administration.
I hereby affirm, under the penalties of perjury, that the foregoing
representations are true and accurate.
Dated this _ _ day of _ _ _ _, 2003.
SIGNATURE OF HEIR
CoraN-
~Qglc.
r
Prepared by:
Linda Clark Dague, Attorney #4744- I 8
DAGUE & BUCK, LLP
1 100 South Martin Luther King, Jr., Blvd.
Suite 2
Muncie, Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE OF
_ _ _ _ _ _ _ , DECEASED
LCDllgalProbatelVI
.consent
STATE OF INDIANA
)
) SS:
COUNTY OF DELA WARE )
IN THE DELA WARE COUNTY COURTS
2003 TERM
IN THE MATIER OF THE ESTATE
OF __________~~~
DECEASED.
CAUSE NUMBER: ISCO________
PROOF OF WILL BY SUBSCRIBING WITNESS
Comes now _ _ _ _ _ _ _ _, being fust duly sworn on oath and says:
I. Affiant is one of the subscribing witnesses to the foregoing instrument
dated _ _ _ _ _ _ _ _--', purporting to be the Last Will and Testament of
_ _ _ _ _ _ _ _ _ (hereinafter called the decedent).
2. That such instrument was on the date thereof duly executed, published,
and declared by such decedent to be the Last Will and Testament of such decedent.
3. That at such time, such decedent was of the full age of eighteen (IS)
years, of sound and disposing mind and memory, under no coercion, compulsion, or
restrain, and competent to devise hislher property.
4. That such decedent signified that such instrument was hislher Last Will
and Testament and duly executed the same in presence of the subscribing witnesses
thereto; namely, the affiant and _ _ _ _ _ _ _ __
5. That in the presence of such decedent and in the presence of each other,
each of such subscribing witnesses attested and signed the same as witnesses thereto.
I swear or affum under the penalties for peIjury in the State of
Indiana that the foregoing representations are true this
day of
,2003.
WITNESS
~(ooft* ~ll­
~SrlQ.4L
r
Prepared by:
Linda Clark Dague
Attorney #4744-18
DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd.
Suite 2
Muncie, Indiana 47304
LCD~galProbatelV/
.proof
r
Form
55-4
Application for Employer Identification Number
(For use by employers, corporations, partnerships, trusts, estates, churches,
government agencies, certain individuals, and others. See instructions.}
(Rev April 2000)
Department 01 the
E'N
OM8 No. 1545-0003
Tre~suri
.... Keep a copy for your records.
Internal Revenue Service
1
Name of applicant (legal name) (see instructions)
"
2
Trade name of business (if different from name on line 1)
"
4a Mailing address (street address) (room, apt., or sUite no.)
5a Business address (If different from address on lines 4a and 4b)
4b City, state, and ZIP code
5b City. state, and ZIP code
,;..
~
3
Executor, trustee, "care of" name
~
u
"§.
~
~
Co
)';'
~
~
6
County and state where principal business is located
7
Name of principal officer, general partner, grantor, owner, or trustor-SSN or ITIN may be required (see instructions)
~
~
0:
8a
~
Type of entity (Check only one box.) (see instructions)
Caution: If applicant is a limited liability company, see the instructions for fine Ba.
o Sole proprietor (SSN)
o Es1a1e (SSN of deceden1)
o Partnership
o Personal service corp. 0 Plan administrator (SSN)
o REMIC
o National Guard
0 Other corporation (specify) ~
o State/local government 0 Farmers' cooperative 0 Trust
o Church or church-controlled organization
0 Federal governmenVmilitary
o Other nonprofit organization (specify) ... _ _ _ _ _ _ _ _ _ _ _ _ (enter GEN if applicable) _ _ _ _ _ _ _ _ _ _ _ _ __
o Other (specify) ~
8b
9
If a corporation. name the state or foreign country
(if applicable) where incorporated
Reason for
o
app~ying
(Check only one box.) (see instructions)
Started ne ..•.. business (specify type) .... _ _ _ __
o Hired employees (Check the box and see line 12.)
o Created a penSion plan (specify type) ....
Foreign country
State
o
o
o
o
Banking purpose (specify purpose) ....
Changed type of organization (specify new type) ~ _ _ _ _ _ _ _ __
Purchased going business
Created a trust (specify type) ....
o
01her (specify) ..
11 Closing month of accounting year (see instructions)
10
Date business started or acquired (month, day, year) (see instructions)
12
First date wages or annuities were paid or will be paid (month, day, year). Note: If applicant IS
first be paid to nonresident alien. (month, day, year) .
~
13
Highest number of employees expected in the next 12 months. Note: If the applicant does nor
exoect to have any employees during the period, enter -0-. (see instructions)
....
14
PrinCipal activity (see instructions) ....
15
Is the principal business activity manufacturing?
If "Yes," principal product and raw material used ....
16
o Public (retail)
17a
Has the applicant ever applied for an employer identification number for this or any other business?
Note: If "Yes, " please complete lines 17b and 17c,
17b
If you checked "Yes·' on line 17a, give applicant's legal name and trade name shown on prior application, if different from line 1 or 2 above.
Legal name....
Trade name ~
17e
Approximate date when and city and state where the application was filed. Enter previous employer identification number if known.
ApprOximate dale when filed (mo., day, year) City and state where filed·
Previous EIN
a withholding agent, enter date income will
Household
Nonagricultural
DYes
D
To '.vhom are most of the products or services sold? Please check one box.
Other (specify) ....
0
Business (wholesale)
Under Denailies ·JI perlury. I declare thai I have examined this applicaliOn, and 10 the besl of my knowledge and belief. It IS true. correct. and complete.
DYes
o
No
o
N/A
o
No
Business telephone numbel (include area
co~e)
Fax telephane number (include area code)
Name and title (Please Iype or print clearly) ....
Signature ....
Note: Do not write below this line. For official use (
I
Please leave Geo
blank ....
I 'cd.
For Privacy Act and Paperwork Reduction Act Notice, see page 4.
Cat No
r
DAGUE
& BUCK,LLP
A ttamers at Lall'
1100
s.
Mal1in Luther King Jr.. Blvd .. Suit.: 2
MUllCll'. Inlllana 47304
TELEPHO'<E (765) 2X9--1<05
FAX (765) 2R9--'50-;
LI'lDA CLARK OAliL'[
MARY LOlilSE DAGlIl: BlCK
Date
Address
Re:
E~meof~____~_________
Cause Number: 18CO_______
Dear _ _ __
Enclosed is the following document for your information and review:
L Inventory and Appraisement of Property_
Please review the original inventory, and, if it is correct for
probate assets only, please sign and date where indicated and return to me in the
enclosed, po~age-paid return envelope_
Please do not hesitate to contact me if you have any que~ionsabout these
documents_
Very truly yours,
DAGUE & BUCK, LLP
Linda Clark Dague
Enclosure
LCDtlgalProbateIV/_ _ _ _ .letter_inventory
r
STATE OF INDIANA
)
) SS:
COUNTY OF DELA WARE )
2003 TERM
IN THE MATTER OF THE ESTATE
CAUSE NUMBER: 18CO,_ _ _ _ __
IN THE DELA WARE COUNTY COURTS
OF
_ _ _ _ _ _ _ _ , deceased.
INVENTORY AND APPRAISMENT OF PROPERTY
DAGUE & BUCK. LLP
1100 South Martin Luther King Jr., Blvd., Suite 2
Muncie, Indiana 47304
(765) 289-4505
By: _ _ _ _ _ _ _ _ _ _ _ _ ____
Linda Clark Dague
Attorney # 4744-18
ATTORNEYS FOR THE ESTATE
OF
,DECEASED
lCDllgalProbatelll/,_ _ _ _ .inventory
r
PERSONAL REPRESENTATIVE OF THE ESTATE OF
INVENTORY AND APPRAISEMENT
Date of Death: _ _ _ _ _ _ _ __
An inventory and appraisement of the probate estate of--:----:-_-:-_ _ _ _-:-'
deceased, and a statement of all known encumbrances, liens, and other charges on any item taken
by
, Personal Representative ofthe Last Will and Testament of said
decedent, at the fair market value thereofas of the date of the death of the decedent as follows:
SCHEDULE NO.1
Real Estate
NET REAL ESTATE
$
SCHEDULE NO.2
Furniture, Household Goods, and Miscellaneous
TOTAL FURNITURE, HOUSEHOLD
GOODS, AND MISCELLANEOUS
$
SCHEDULE NO.3
Emblements and Annual Crops
TOTAL EMBLEMENTS AND CROPS
$
SCHEDULE NO.4
Corporate Stock
TOTAL CORPORATE STOCK
$
SCHEDULE NO.5
Mortgages, Bonds, Notes or Written Evidence of Ownership
TOTAL BONDS, NOTES,
AND MORTGAGES
$
SCHEDULE NO.6
Bank Accounts, Money and Insurance
$
TOTAL BANK ACCOUNTS, MONEY
$
SCHEDULE NO.7
All Other Personal Property
TOTAL ALL OTHER PROPERTY
$
TOTAL INVENTORY AND APPRAISEMENT
$
RECAPITULATION
I. Real Estate
$
2. Furniture and Household Goods, and Miscellaneous
$
3. Emblements and Crops
$
4. Corporate Stock
$
5. Bonds, Notes, and Mortgages
$
6. Bank Accounts, Money
$
7. All Other Property
$
TOTAL INVENTORY AND APPRAISEMENT
$
Dated this _ _ _ day of _ _ _ _ _ _, 2003.
===-==-===-=-=-__' PERSONAL REPRESENTATIVE
OF THE ESTATE OF _ _ _ _ _ _ _ _ _ ___
Personal Representative
STATE OF INDIANA
)
) SS:
COUNTY OF DELAWARE )
_ _ _ _ _ _ _ _ _ _ _ _, being duly sworn, says:
That he/she is the personal representative of the Estate of _ _c--_-,-_ _-,-_
deceased, and that the foregoing instrument contains a complete statement of all of the probate
property of the decedent which has come to his/her knowledge or possession at the fair market
values thereofas of the date of death of said decedent.
I swear or affirm under the penalties of perjury of the State of Indiana, that the
above and foregoing representations are true, this
day of
, 2003.
Personal Representative
LCDngalProbateIlI/_ _ _ _ _ .inventOI)'
r
STATE OF INDIANA
)
) SS:
COUNTY OF DELAWARE )
IN THE DELAWARE COUNTY COURTS
IN THE MATTER OF THE ESTATE
CAUSE NUMBER: 18C_ _ _ __
2003 TERM
OF _______________________
DECEASED.
CERTIFICATION OF INVENTORY
Comes now the personal representative of the Estate of
__________________ , deceased, by counsel, Linda Clark Dague, and certifies
that the inventory required under Indiana Code § 29-1-7.5-3.2 (a), has been prepared and
has been provided to the legatees.
Respectfully Submitted:
Linda Clark Dague, Attorney
LINDA CLARK DAGUE
Attorney # 4744-18
DAGUE & BUCK, LLP
1100 South Martin Luther King, Jr., Blvd.
Suite 2
Muncie, Indiana 47304
(765) 289-4505
ATTORNEYS FOR THE ESTATE OF
_ _ _ _ _ _ _ _ _ _ _ _ _ , DECEASED
LCD~galProbalelIl/,_ _ _ _ _ _ .certificalion