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- OFFIMA'.PROBATE FORM 19 PROBATE CODE, SEC. 112 <br /> This Form Has Been Officially Prescrib...,y the Supreme Court of Arkansas for use under the ProblvoeWe.Act 140 of the 1444 Acts of Arkansas. <br /> IN THE PROBATE COURT OF------------ .}lnED----------- COUNTY, ARKANSAS <br /> MZOCT 30 A IF, V <br /> IN THE MATTER OF THE ESTATE OF k�f��ff[� <br /> ALICE L. HOLM o------------------------------921169 F � �� <br /> 1 ROBATE CLER6 U <br /> ' <br /> FULASEKI C-'GUHTY. ARK ENVIRONMENTAL WEALTH <br /> PERMIT/SERVI'- <br /> EUGENE H. HIETT---------------------------deceased <br /> AFFIDAVIT TO CLAIM AGAINST ESTATE <br /> I,*_____________________________ WILIBALDO RUIZ <br /> --------- -------------------------------------------------------------------------------------------- <br /> • <br /> do solemnly swear that the attached claim against the estate of......EUGENE "H. HIETT <br /> -------- -------------------- <br /> --------------------------------------------------------------------------------- deceased, is correct, that nothing has been paid <br /> or delivered toward the satisfaction thereof except what is credited thereon, that there are no offsets <br /> to the same, to the knowledge of this affiant, except as therein stated, and that the sum of <br /> -- currently unascertainable amount <br /> is now justly due [or will or may become due as stated therein]. I further state that if this claim is <br /> based upon a written instrument, the copy thereof, including all endorsements, which is attached <br /> hereto,is true and complete. <br /> WILIBALDO RUIZ <br /> STATE OF ._-__-CALIFORNIA SAN -" - - - - - - <br /> COUNTY OF-------------JOAQUIN <br /> -------------------------------------------- <br /> Subscribed and sworn to before me, this.M- -day of------------OCTOBER_ - - -- - 1s 9z <br /> OFFICIAL SEPI. <br /> Terry L. Willingham o � <br /> NOTARY PUBLIC-CALIFORNIA �""'� - --= - - - - - ---- -- ---------- <br /> SAN JOAQUIN COUNTY <br /> my Comm. Expres Feb.21,t <br /> (SEAL) NOTARY PUBLIC <br /> -------- ----------------------------------------------------------------------- <br /> ( Official Title ) <br /> •If the affidavit is made by anyone other than an individual in his own behalf,the representative capacity of the affiant must be clearly stated- <br />