STATE OF INDIANA ) IN THE DELA WARE COUNTY COURTS ) SS:

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STATE OF INDIANA )

) SS:

COUNTY OF DELA WARE )

IN THE MATTER OF THE ESTATE

IN THE DELA WARE COUNTY COURTS

2003 TERM

DISTRIBUTION RECEIPT AND AGREEMENT TO REPAY

ESTATE UPON CERTAIN CONDITIONS

Description: The sum of --c1 personal property valued at $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and partiaVfull and final satisfaction of my interest in said estate and in consideration thereof, I agree, upon demand, to repay immediately and refund the funds and/or property above described, if funds and/or property be required for the payment of any tax, expense, claim or other liability of said estate on my behalf.

I swear or affirm under the penalties for perjury that the above representations are true.

Distributee

Distributee's Social Security Number

Linda Clark Dague. Attorney #4 744-18

DAGUE & BUCK- LLP

1100 S. Martin Luther King, Jr., Blvd., Suite 2

Muncie. Indiana 47304

(765) 289-4505

ATTORNEYS FOR THE EST ATE

OF , DECEASED

Ll)JDA CLARK DA(;UE

MARY LUUISE DAGeE [lUCK

DAGUE &

BUCK,LLP

Atfomcl's at Law

1100 S. MaI1in Luther King Jr .. Blvd .. Suite 2

MuncIe, Indtana 47304

Date

Address

Re: Estate of---,_--:-::~ _

TELEPHO"E (;65\ 2St)-45il5

FAX (765) 2SYA507

L

2,

Personal Representative's Final Accounting;

Personal Representative's Verified Closing Statement to Close

Estate upon Conclusion of Administration;

3, (proposed) Order Approving Verified Closing Statement,

If you are in agreement with the figures in the accounting and the enclosed documents, then please sign them where indicated and return them to me so that I can file them as appropriate with the court, The accounting itself is mailed to the heirs but not filed,

We then must wait three (3) months in the event that any person should object in any way to the documents filed, After three (3) months, we will file the Order Approving

Verified Closing Statement with the court, and upon signature by the judge, the estate will be closed,

I will be looking forward to hearing from you as soon as possible, As always, please do not hesitate to contact me if you should have any questions about this matter,

Very truly yours,

DAGUE & BUCK, LLP

Enclosures

LCDllgalProbate v ;' _ _ _

Linda Clark Dague

'is' t"b'r.

r

ST ATE OF INDIANA )

) SS:

COUNTY OF DELAWARE )

IN THE MATTER OF THE ESTATE

DECEASED.

IN THE DELAWARE COUNTY COURTS

2003 TERM

CAUSE NUMBER: 18C __________ _

PERSONAL REPRESENT A TIYE'S VERIFIED

CLOSING STATEMENT TO CLOSE ESTATE

UPON COMPLETION OF ADMINISTRATION

Comes now _ _ _ _ _ _ _ _ _ as personal representative of the alleges as follows:

I. That on _ _ _ _ _ _ _ _ his/her Last Will and Testament dated _ _ _ _ _ _ _ _ _ _ was duly admitted to probate by this Court.

2. That your petitioner was appointed personal representative of the hirnlher on that date, and said petitioner was authorized to proceed under the provisions of the Indiana Code governing unsupervised estates.

3. That notice ofhislher appointment as personal representative of the estate of _ _ _ _ _ _ _ _ _ _ was first published to creditors on

_ _ _ _ _ _ _ _ _ 2003, in The Star Press, and that three (3) months have elapsed since the first published notice to creditors.

4. That the petitioner has fully administered the estate of the decedent in that he/she collected all the assets of the estate that have come to his/her knowledge; has

made payment, settlement, or other disposition of all claims which were presented; and has paid expenses of administration, Federal and State Estate and Inheritance Taxes, and

Federal and State Income Taxes of the deceased,

5, That no claims were filed in the decedent's estate,

6. That a copy of the closing statement has been sent to all distributees, creditors, and claimants as listed below:

7. That all the assets of said estate have been administered upon, and no reason exists why this estate cannot be closed at this time. That said petitioner has forwarded a copy ofhis/her accounting and this closing statement to all heirs and distributees and the said accounting and closing statement shall serve as notice upon said distributees of their respective interests in the decedent's estate.

8. That the decedent died owning a _ _ interest in the following parcel of real estate located in Delaware County, Indiana, of which no sale or other disposition was made during the period of administration. Said real estate is more specifically

That Article of the decedent's Last Will and Testament devised all title and interest in this property to , and title in the real estate has vested in

_ _ _ _ _ _ _ pursuant to a deed executed by the personal representative in accord with the provisions ofle § 29-1-7.5-3.6 and recorded by the estate.

statement for the purpose of closing this estate and terminating the appointment of the undersigned pursuant to IC

§

29-1-7.5-4 on this _ _ _ day of _ _ _ _ _ _ _

2003.

-::-_____

as 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

ATTORNEYS FOR THE ESTATE OF

STATE OF INDIANA )

) SS:

COUNTY OF DELA WARE )

IN THE MATTER OF THE ESTATE

DECEASED.

IN THE DELAWARE COUNTY COURTS

2003 TERM

ORDER

APPROVING

VERIFIED

CLOSING STATEMENT

Comes now _ _ _ _ _ _ _ _ _ _ as personal representative of the

Closing Statement which is on file with the court and a part of the court's record.

And the court, having examined said document and being duly advised in the premises, now fmds that no actions or objections have been brought against said personal representative with regard to the distribution of the assets as set forth in the

Closing Statement filed over three (3) months ago.

IT IS THEREFORE ORDERED, ADJUDGED, AND DECREED by the court that the Closing Statement, being in order, is hereby approved by the court,

and

said further responsibility as set forth in I C

§

29-1-7.5-4, and her appointment is terminated.

,JUDGE

-D-=E-LA-W:-::-A-:-RE-::-:C:--:O:-UN~T'CO'Y::-C=I=-R-=CUIT

COURT NO.

r

Prepared by:

Linda Clark Dague

Attorney #4 744-18

DAGUE & BUCK, LLP

1100 South Martin Luther King, Jr., Blvd.

Suite 2

Muncie, Indiana 47304

ATTORNEYS FOR THE ESTATE OF

r

Send tax statements to:

QUIT-CLAIM DEED and in consideration of the sum of One Dollar and other valuable consideration, the receipt whereof is hereby acknowledged, the following described real estate in Delaware County, State of

Indiana, to-wit:

Unit Tax Number:

Grantee's Address:

IN WITNESS WHEREOF, The said

' has hereunto set hislher hand and seal, this

Page One of Two

GRANTEE

~u\~ -t\ru.t:s bud

J

r

STATE OF INDIANA )

) SS:

COUNTY OF DELAWARE ) day of , 2003, came acknowledged the execution of the foregoing instrument.

Witness my hand and official seal.

Linda Clark Dague (Printed Name) a Notary Public, a resident of Delaware County, Indiana

My Commission Expires:

February 12, 2008

This instrument prepared by Linda Clark Dague, Attorney #4744-18,

DAGUE & BUCK. LLP, 1100 South Martin Luther King, Jr., Blvd., Suite 2

Muncie, Indiana 47304

' and

Page Two of Two

SALES DISCLOSURE FORM

Stale Form 46021 (R311-00)

Approved by Stale Board ot A·:counls, ::000

Prescllbed by the Stale Board 1)1 raA COrTlmISSlC)l1er$

1999

I (S) I Last name(s)

I

Primary reSidence?

DYes

Slate

DNa

ZIP code

Fist name(S)

Acdress (number and streel)

Town or Post Office

S:ree\ address

C.ly. Town or Post code)

Pursuant to Ie 6-1 '·55

DATE OF SALE

1. Total sales price $

I

$ ( 2_ Seller paid points

3. Net sales price (line 1 minus line 2) $

::: --:-'ans~el of enNe parcel

::; Se,~er provided ~Inanc!ng

Checil ALL of the following conditions that apply to this sale. o Vacant land o Exchange for other real property ("Trade')

::J \\Jbile home

:: EXIster:ce 0' famdy or bUSiness reiat;Qnsl',:p t:erween tlu}er ana seiler o Co~domlnlum oSplrt(S) o Personal properw Induded In transfer (ESllmaled value

Describe Clny unusual or Spec'ClI circumstances related to this sale, including the specification of any less-than-complele ownership interest, and i the terms of any seller financing.

---

~-

, '

-------

PART Z. To be completed by COUNTY AUDITOR (see Insrructlon. on

: County AuditOr must verify and complete the fOllowmg information:

- - -

_elSe side)

-

:: Euyer and Seiler Information

:::: Saies prICe

- - -

o Parcel J Key number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

: '::' Acdress of propeny transferred :J Condlt'ons of sale

: 0 Date of sale.'ransfer

-

- - - -

-

- -

- - - - - - - -

-

--

PART 3 - To be completed by COUNTY ASSESSOR (sel>/nsttucUons on """'ISO side)

County AsseSsor must verity .. nd complete the followmg 'nformation:

OWarranty deed? 0 YES 0 NO

---

- - - -

ASSESSED VALUE lAY) INFORMATION

,I

=

:0 i)fCpeny !:Ietween Marcn 1 and dale of sale

AV LAND $

-

I CJ Current propeny record .;arc a\(ac~eo

!

0 Propeny class i use code _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ i

AV IMPROVEMENT(SI $

AV TOTAL $

~

!

I

The part,es to a real propefty conveyal"\ce are reqUlrea 10 file :h15 form al"\d attest il"\ writing and under the penalties 01 peljury Ulat the Inlorm.al!on contamed

!

herem IS true and correct. A person who knOWingly and Il""I!enl,onally fatslfies or omits any Informat'on requ,red on th,s form comm'ts a Class A mfrOlction

.: Under penalties of perjury, I hereoy certify that thiS Sales Disciosure, to the best of my knowledge and belief, is true, correct and:cdmplete as required i by law. and is prepared in accordance WIth Ie 6-1 1-5.5. "'Real Property Sales Disclosure Act."

!

Signature of Seiler or repreSentative

Telephone number Date signed

SlgnatL.:le 01 BLJyer or representative

I Telephone number i

Date Signed

__

~

,

--,

r

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Instructions for Completing the Sales Disclosure Form l

Indiana IaN requires a sales disclosure '~rm to be c:ln'ple'eo ",hen a conveyance document \see definition below for use

of this form}:5 flied with the county auditor The count')' auditor rT]ay nct accepl a conveyance document If (1) the sales disclosure form

IS not Included with the conveyance rhcument. or (2) the sales disclosure form IS Incomplete A person filing a sales disclosure form shall pay a fee of five dollars (S5 00) to the county auditor

I

Part 1: Buyer, Seller, Exempt Transaction and Sales Information Section

Buyer and Seller Information. The full first name, middle

<nltlal, and last name

IS requested from the buyer and seller

Each transferor and transferee must provide their current address (use additional sheets if necessalY) Either the buyer or the seller should p~ovlde the full address. county. township, and school corporation for the property to be transferred

The buyer and seller must also Indicate If the property IS the primary residence by Checking the appropriate box

Sales Information. The date of the property transfer 6 to be printed In the space provided. The selling pnce of the property should be listed In line 1 of Ir.e ··Sales Information" If the seller paid any pOints or fees to facilitate the transaction. the dollar value of those IS requested In line 2 The ~!et Sales Price IS the dollar amount of line 1 less line 2.

Exempt Transaction. If the transactron meets one of the conditions listed belOW, please mdicate in the "Exempt

Transaction" section that the transaction IS exemot and provide the reasor. number. Data in the "Sales Information" section does not have to be completed for an exempt transactIOn

1 Mortgages and other security Interest documenrs

2 Leases

3 A document resulting from a foreclosure or express threat of foreclosure, divorce, court order. condemnation. probate or other JudiCial proceedings (examples Include shenff's deed or trustee's deed)

4 Transfer to I from a chanty. non-prof~t or government Institution

5 Agreements and other documents for mergers, :onsolldatlOns and incorporations

6 Quitclaim deeds not serving as a source of title

7 Transfer for no or discounted conSideratIOn. or g1ft

8 Documents invoiving the partition of land

9. Re-reccrdmg to correct pnor recorded document

10 Easements. Right-ai-way grants

11 Contract sale or deeds issued at front-end of sale or upon completion 01 contract sale

Sales Condition. For all the conditions that apply

~o the sale. the appropriate box or boxes must be checked. At least one (1) of the boxes in thiS sectlcn must be checked. With regard to personal property (see below). the buyer or seller must enter an estimated va:ue of the personal property Included in the sale. Any unusual or special conditions of the sale that may affect the saies pr:ce or terms of the sales agreement should be described.

Part 2: County Auditor Section

The county auditor is respons,ole 'or \Ier'rjlng that the buyer and seller have completed Part 1 of the sales disclosure form if Part 1 of the sa;es dlscioSiJre fo~~ ;s complete. ;he county auditor must enter the parcel number for the property t:emg ;ransferred, Schooi COfpOra,;Q:1 Name and ,ndicate whether the transfer Involves a warranty deed. in the event that

~he ~uyer and

.r or seller fails to campiete ail '.X portIOns of Part 1 of the sales disclosure form, the county auditor may not accept a conveyance document fer the property oelng :ransferred. In addition, the county auditor is to verify that the buyer and seller have signed the sales dlscloS'Jre form (see Part 4' Signature and Verification Section)

Part 3: County Assessor Section

The county assessor is responsible fer determining whether or not significant physical changes have been made to the property bet'Neen March 1 and ;he date of sale. If so. the county assessor should check the appropriate box. An example of thiS would be a recently constructec house or bUilding. After attaching the current property record, the county assessor must check the indicated box and enter :he current property class code. Based on the current property record card, the county assessor must enter the current assessed value (AV) for the land, improvements and the total AV in the space

:JfOvlded (NOTE: In Manon County, township assessors are responsible for this section)

Part 4: Signature and Verification Section

The seiier, buyer. or their representatives must Sign ene (1) sales disclosure form, or if the parties do not agree on the

InformatIOn to be included on the completed form, each party must sign and file a separate form. If anycne other than the buyer, seller, or an attorney IS filling out !ne form (e.9. bank offiCial. title company offiCial, or realtor), a Power of Attorney must"be completed and attached A person whe knOWingly and intentionally falsifies or omits any information required on this form commits a Class.A. Infraction

Definitions

Conveyance document means any docurT'ent, deed. qUitclaim deed serving as a source of title, or other document presented for recordlflg, that purports to transfer a real property mterest for valuable consideration

Personal property - For residential sales, personal property includes Items that are not attached (built-in) to the home. This

'ncludes, but IS not limited to Items such as washers, dryers, drapes, stoves, refrigerators, and dishwashers. For agricultural sales, personal property items may rr·:iude gram, livestock. and farm machinery and equipment. For commercial and industrial sales, personal property Includes ,.1\/entor,es and depreciable assets

DAGUE & BUCK, LLP

ESTATE DEADLINES

Decedent's Name:

Cause Number:

------------------------------

Date Estate Opened I

Court: ________________ _

Decedent's Date of Death: I I

- - - - - - -

Decedent's Social Security Number: _____________________ __

Estate Federal Identification Number:

---------------------

Personal Representative: _________________________________ __

Representative'S Address: _______________________________________________________ _

Home Phone: (----1 ____________ __

Business Phone: ( ) ____________ _

Date Appointed: I

Bond Required? _____ Yes _____ No

Inventory Due: _____ I

Inventory Filed: ____ I

1------

Was more than I inventory filed? ____ Yes ___ No

Ifso, list: _______________ __

Claim period expired:

Were there any claims against the estate? ___ Yes ___ No

If so, how many? _______ _

Federal Estate Tax Return due: I

Federal Estate Tax Return filed:

I

------

I I

---- ---- ------

------

Indiana Inheritance Tax Return filed: ____ ____ 1 ____ __

Decedent's Final Income Tax Return due: I /

- - - - - - -

Decedent's Final Income Tax Return filed:

Fiduciary Income Tax Return due: ___ ___

- - -

I

______ _

I

----

- - - - - -

Fiduciary Income Tax Return Filed: ____ ___

Final Reportl Accounting Filed: ___ ___ 1

Supplemental Report fiied:

Estate closed:

; ;

----------

/ I

---- - - -

- - - - -

LCD/fga/GenerallEstate Deadlines Form

STATE OF INDIANA )

)

) SS:

)

COUNTY OF DELAWARE )

IN THE MATTER OF THE ESTATE OF

DECEASED.

IN THE DELA WARE COUNTY COURTS

2003 TERM

PETITION FOR PROBATE OF WILL WITHOUT ADMINISTRATION

(Will Spread of Record)

and

at the time ofhislher death was domiciled in Delaware County, Indiana. and said Will is submitted to the court herewith.

3. That the names, ages, addresses, and relationship to the decedent of named legatees and devisees in her Last Will and Testament are:

4. That the value of the decedent's gross probate estate, less liens and encumbrances, does not exceed the sum of Twenty-Five Thousand Dollars ($25,000), and petitioner is merely requesting Probating the Will and Spreading the Same of Record as there are not sufficient probate assets to require appointing and qualifying the personal representative.

5. That the personal representative named in the decedent's Last Will and

Testament is _ _ _ _ _ _ _ _ _ _ whose address is provided above.

6. The said Will is self-proved.

~-

WHEREFORE, the Petitioner herein prays the court for an order probating the decedent's Last Will and Testament and having the same Spread of Record.

SUBSCRIBED and sworn to before me this _ _ ., 2003.

Linda Clark Dague (Printed Name)

Notary Public, a resident of Delaware County

My Commission Expires:

February 12. 2008

This instrument 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

STATE OF INDIANA )

)

) SS:

)

COUNTY OF DELAWARE )

IN THE MATTER OF THE ESTATE OF

DECEASED.

IN THE DELAWARE COUNTY COURTS

2003 TERM

ORDER OF PROBATE OF WILL WITHOUT ADMINISTRATION

(Will Spread of Record) for Probate of Will Without Administration, which petition is on file with the court and a part of its record.

Further, there is now produced in open court and submitted to the court which instrument is self-proved. Such Will and petition are now submitted to the court and the court having examined the same, having heard evidence and being duly advised, now finds: time of such death was domiciled in Delaware County, Indiana.

2. That such written instrument purporting to be such decedent's Last

Will and Testament was duly executed in all respects according to law, is self-proved, and is the Last Will and Testament of such decedent, and is entitled to be admitted to probate in Delaware County, and that. such Will and petition are on file with the court.

AFFIDAVIT FOR TRANSFER OF CERTIFICATE OF TITLE FOR

A VEHICLE / WATERCRAFT WITHOUT ADMINISTRATION

Slate Form 18733 (R3/ 1-98)

.. -

-

STATE OF

COUNTY OF

}

53

I , being first duly sworn on

(decedent) died on the _ _ day of

Date (month, day. year)

1 That o leaving a wiil o without leaving a will (check one) while domiciled in depose and say:

, 19

- - county, Indiana.

2. That no petition for the appointment of a personal representative of this estate is pending or has been granted.

I

3. That more than jive (5) days have passed since the death of the decedent.

4. That the value of the entire assets of the estate of the decedent, wherever those assets are located, after substracting-any liens and encumbrances, does not exceed $25,000.00.

Year

5. That this affiant is a o widow o distributee of the decedent and

IS entitled to receive without administration the following vehicle from the person, firm or corporation listed below subject to the liens and encumbrances thereon.

Make Type

Title number Manufacturer's I Hull Identification Number

Name of person, firm or corporation holding property of decedent

~

- ,

-

-

This affidavit is made to induce the Commissioner of Motor Vehicles to issue a Certificate of Title for thi.s vehicle:

1. o to the affiant; or

2. o to the purchaser of the vehicle as evidenced by the assignment of title made by the affiant.

I

I

1

I

Affiant swears or affirms that the information he / she has -entered on this form is correct. He I she understands that making a false statement on this form may constitute the crime of perjury.

-

Signature Address

Date ·signed (month, day, year)

--

STATE OF INDIANA )

) SS:

COUNTY OF DELAWARE )

IN RE THE GUARDIANSHIP of

IN THE DELAWARE COUNTY COURTS

2003 TERM

AN INCAPACITATED ADULT.

NOTICE OF FILING OF PETITION FOR APPOINTMENT OF

GUARDIAN AND HEARING THEREON TO:

PERSONAL SERVICE TO:

No. of Delaware County, Muncie, Indiana, a hearing will be held to detennine whether attached to this notice. At the hearing the court will determine whether

_ _ _ _ _ _ _ is an incapacitated person under Indiana law.

If the court fmds that _ _ _ _ _ _ _ is an incapacitated person, the court at the hearing shall also consider whether _ _ _ _ _ _ _ should be appointed as qualified person as guardian. The court may also, in its discretion, limit the powers and duties of the guardian to allow _ _ _ _ _ _ _ to retain control over certain property and activities. The court may also detennine whether a protective order should be entered

_ _ _ _ _ _ _ may attend the hearing and be represented by an attorney.

The petition may

be

heard and determined in the absence of _ _ _ _ _ _ _ if the court determines that the presence of _ _ _ _ _ _ _ is not required. If

_ _ _ _ _ _ _ attends the hearing, opposes the petition, and is not represented by an attorney, the court may appoint an attorney to represent the alleged incapacitated person.

The court may, where required, appoint a guardian ad litem to represent

_ _ _ _ _ _ _ at the hearing.

The court may, on its own motion or on request of any interested person, postpone the hearing to another date and time.

By:

_-::-:--=--=--:-=:--_ _

Linda Clark Dague

Attorney #4744-18

CERTIFICATE OF SERVICE

I hereby certifY, under the penalties for perjury, that I have served a copy of this

Notice and Petition for Guardianship on

2003, by delivering a copy of the Notice and Petition for Guardianship to

_ _ _ _ _ _ _ and by reading the same to him.

Sheriff of Delaware County, Indiana

By:

-----~------------------

Deputy

Linda Clark Dague

Attorney #4744-18

DAGUE & BUCK, LLP

1100 Martin Luther King, Jr., Blvd., Suite 2

Muncie, Indiana 47304

(765) 289-4505

ATTORNEYS FOR PETITIONER

r

STATE OF INDIANA )

) SS:

COUNTY OF DELAWARE )

IN RE THE GUARDIANSHIP of

IN THE DELAWARE COUNTY COURTS

2003 TERM

AN INCAPACITATED ADULT.

ACCEPTANCE AND OATH OF GUARDIAN

APPOINTED OVER PERSON OF INCAPACITATED PERSON

_ _ _ _ _ _ _ _ _ _ accepts the court's appointment as guardian faithfully discharge his/her duties as guardian as enumerated by the court's order.

I swear or affrrm under the penalties for perjury of the State of Indiana,

2003.

Linda Clark Dague

Attorney #4744-18

DAGUE & BUCK, LLP

1100 Martin Luther King, Jr., Blvd., Suite 2

Muncie, Indiana 47304

(765) 289-4505

ATTORNEYS FOR PETITIONER

r

STATE OF INDIANA )

) SS:

COUNTY OF DELAWARE )

IN THE DELAWARE COUNTY COURTS

2003 TERM

IN RE THE GUARDIANSHIP of

AN INCAPACITATED ADULT.

LETTER OF GUARDIANSHIP

THE STATE OF INDIANA, DELAWARE COUNTY, ss: certify that

I, Karen D. Wenger, Clerk ofthe Circuit Court No.2 of Delaware County, of appointed guardian of the person of

County, , has been

' an incapacitated adult, of

Delaware County, and has qualified as such. said court this

IN TESTIMONY WHEREOF, I have hereunto set my hand and

seal

of day of ' 2003.

KAREN D. WENGER, CLERK

DELAWARE COUNTY CIRCUIT COURT 2

Linda Clark Dague

Attorney #4744-18

DAGUE & BUCK, LLP

1100 Martin Luther King, Jr., Blvd., Suite 2

Muncie, Indiana 47304

(765) 289-4505

ATTORNEYS FOR PETITIONER

LEITER OF GUARDIANSHIP

GUARDIANSHIP OF

GRANTED TO

day of _ _ _ _ _ _ _ _

2003.

r

STATE OF INDIANA )

) SS:

COUNTY OF DELAWARE )

IN THE DELAWARE COUNTY COURTS

2003 TERM

IN RE THE MARRIAGE OF

Petitioner, and

Respondent.

DECREE OF DISSOLUTION OF MARRIAGE

This cause of action is now submitted to this court upon the petitioner's Petition for Dissolution of Marriage and the parties' Verified Waiver of Final Hearing, which petition and waiver are in the following words and figures, to-wit:

(H.I.)

And it appearing to the court that the respondent was duly served with process as appears by the Return of Certified Mail, which Summons and Return are in the following words and figures, to-wit:

(H.I.)

And it appearing to the court that this cause of action has been duly filed for more than sixty (60) days and that said cause is at issue, the same is now submitted to the court.

The court fmds that the petitioner is and has been a bona fide, continuous resident of the State ofindiana for six (6) months and Delaware County for three (3) months immediately preceding the date of filing of the above cause of action.

The court having read and examined said Verified Waiver of Final Hearing now fmds that said waiver is in proper form and that the parties have waived the right to a fmal hearing pursuant to Indiana Code Section 31-15-2-13.

The court further finds that the marriage has suffered an irretrievable breakdown and that the parties are entitled to a dissolution of their marriage, and that the petitioner/respondent is not pregnant.

The court further finds that the petitioner' s/respondent' s former name of

_ _ _ _ _ _ _ _ _ should be restored.

The court further fmds that the parties have entered into an agreement entitled,

"PROPERTY SETTLEMENT AGREEMENT," which Agreement is in the following words and figures, to-wit:

(H.I.) and which Agreement is hereby approved by this court and incorporated by reference as a part of and merged into this Decree of Dissolution of Marriage.

IT IS, THEREFORE, ORDERED, ADJUDGED AND DECREED by this court that the petitioner's Petition for Dissolution of Marriage and the parties' Verified Waiver of Final Hearing are hereby approved and granted in all respects.

IT IS FURTHER ORDERED, ADJUDGED AND DECREED by this court that the marriage of the parties has suffered an irretrievable breakdown, and their marriage is hereby dissolved.

IT IS FURTHER ORDERED, ADJUDGED AND DECREED by this court that the petitioner's/respondent's former name of is hereby restored to her. and she shall hereafter be known as _ _ _ _ _ _ _ _ _ _ _

IT IS FURTHER ORDERED, ADJUDGED AND DECREED by this court that the Agreement entered into by the parties is approved in all respects and is incorporated by reference as a part of this Decree and made a part hereof as though set forth herein at length.

IT IS FURTHER ORDERED, ADJUDGED AND DECREED by this court that the parties shall execute any and all instruments necessary to effect the findings of this

court, and shall comply with the findings of this court, and upon failure to do so, the aggrieved party may enforce this Decree by contempt proceedings for any violation thereof, and that this court shall retain continuing jurisdiction over the parties, including the powers of contempt, for the enforcement of this Decree and all parts thereof.

DELA WARE

CIRCUIT

COURT No.

Distribution:

Linda Clark Dague

Attorney #4744-18

DAGUE & BUCK, LLP

1100 Martin Luther King, Jr., Blvd., Suite 2

Muncie. Indiana 47304

(765) 289-4505

ATTORNEYS FOR RESPONDENT

Court Administrator

LCDllgalDissolution/ .decree

STATE OF INDIANA )

) SS:

COUNTY OF DELA WARE )

IN RE THE MARRIAGE OF

Petitioner, and

IN THE DELAWARE COUNTY COURTS

2003 TERM

Respondent.

VERIFIED PETITION FOR TRIAL RULE 65(E)(2)

TEMPORARY RESTRAINING ORDER REGARDING PERSON upon hislher oath, pursuant to Indiana Rules of Procedure. Trial Rule 65(E)(2), requests the court to issue a Temporary Restraining Order regarding person, and shows the court in support as follows:

1.

PetitionerlRespondent requests that the court enter a Temporary

Restraining Order, without notice, restraining petitioner/respondent from abusing, harassing, disturbing the peace, or committing a battery upon the petitioner/respondent or any child or stepchild of the parties.

2. PetitionerlRespondent requests that the court enter an ex-parte order excluding petitioner/respondent from the petitioner'slrespondent's place

3. Injury will result to the moving party if no immediate order is issued

r

WHEREFORE, petitioner/respondent respectfully requests that the court issue a Temporary Restraining Order, without notice, enjoining petitioner/respondent from abusing, harassing, disturbing the peace, or committing a battery upon the petitioner/respondent or any child or stepchild of the parties, and excluding petitioner/respondent from the above premises, and for all other just and proper relief.

SUBSCRIBED and sworn to before me this _ _ _ _ day of

Linda Clark Dague (Printed Name)

Notary Public, A resident of Delaware County

My Commission Expires:

February 12, 2008

Prepared and approved as to fonn by:

Linda Clark Dague

Attorney #4744-18

DAGUE & BUCK, LLP

1100 Martin Luther King, Jr., Blvd., Suite 2

Muncie. Indiana 47304

(765) 289-4505

ATTORNEYS FOR PETITIONER

STATE OF INDIANA )

) SS:

COUNTY OF DELA WARE )

IN RE THE MARRIAGE OF

Petitioner, and

Respondent.

IN THE DELAWARE COUNTY COURTS

2003 TERM

ORDER GRANTING VERIFIED PETITION FOR TRIAL RULE 65(E)(2)

TEMPORARY RESTRAINING ORDER REGARDING PERSON

Verified Petition for Temporary Restraining Order pursuant to Indiana Rules of

Procedure. Trial Rule 65(E)(2), and the court being duly advised, finds that injury would result if no immediate order were issued and finds that the court should issue a

Temporary Restraining Order regarding person.

IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that petitioner/respondent is hereby restrained from abusing, harassing, disturbing the peace, or committing a battery upon the petitioner/respondent or any child or stepchild of the parties.

IT IS FURTHER ORDERED, ADJUDGED, AND DECREED that petitioner/respondent is excluded from the following premises:

IT IS FURTHER ORDERED, ADJUDGED, AND DECREED that the

Temporary Restraining Order is automatically effective upon service upon the petitioner/respondent. This Temporary Restraining Order is enforceable by all remedies provided by law, including contempt.

Peckinpaugh, master commissioner.

DARREL K. PECKINPAUGH

MASTER COMMISSIONER

COMES NOW WAYNE

J.

LENNINGTON, sole judge of this court, and affmns the fmdings of the master commissioner.

ALL OF WHICH IS ORDERED, ADJUDGED, AND DECREED this

Distribution to:

Linda Clark Dague

Attorney #4 744-18

DAGUE & BUCK. LLP

1100 Martin Luther King. Jr., Blvd.

Suite 2

Muncie. Indiana 47304

(765) 289-4505

ATTORNEYS FOR PETITIONER

WAYNE J. LENNINGTON, JUDGE

DELA WARE COUNTY CIRCUIT COURT NO.5

Personal Service to:

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