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`IN THE CIRCUIT COURT OF BAXTER COUNTY, ARKANSAS
`PROBATE DIVISION
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`flm
`BAXTER COUNTY, ARKA 3%
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`OCT 16 2014
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`0
`lay 00.
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`Clerk
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`IN THE MATTER OF THE ESTATE OF
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`MARY R. KIELHOFER, Deceased
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`No. PR—2014- 3‘43
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`AFFIDAVIT FOR COLLECTION OF
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`SMALL ESTATE BY DISTRIBUTEES
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`Comes Robin K. Scholl, and for the purpose of dispensing with administration of the
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`estate of Mary R. Kielhofer, deceased, states on oath:
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`A. The decedent, Mary R. Kielhofer, aged 87, who resided at Mountain Home in
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`Baxter County, Arkansas, died at Mountain Home, Arkansas, on or about the 12th day of '
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`February, 2014. No petition for the appointment of a personal representative for decedent’s
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`estate is pending or has been granted.
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`B. More than forty-five (45) days have elapsed since the death of the decedent.
`C. The value, less encumbrances, of all property owned by the decedent at the time of
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`death, excluding the homestead of and statutory allowances for the benefit of the widow or
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`minor children, if any, of the decedent, does not exceed $100,000.00. An itemized description
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`and separate valuation of each item of property of the decedent, including the homestead, if
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`any, and the names and addresses of the persons having possession thereof, are as follows:
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`Description of Property, and Extent and Details of
`Encumbrances, if any
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`Valuation Less
`Encumbrances
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`ln Possession Of
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`16 Shares of Prudential Financial, Inc. Stock
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`$1,376.00
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`Prudential
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`Outstanding Prudential Financial, Inc. Check
`No. OOOOXXXXXX dated 3/20/14
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`8.48
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`Prudential
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`
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`Outstanding Prudential Financial, Inc. Check
`No. OOOXXXXXXX dated 6/19/14
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`8.48
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`Prudential
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`Outstanding Prudential Financial, Inc. Check
`No. OOOXXXXXXX dated 9/18/14
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`8.48
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`Prudential
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`D. The decedent left a will.
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`E. There are no unpaid claims or demands against the decedent or her estate. That
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`the Department of Human Services furnished no federal or state benefits to the decedent.
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`F. The names, ages, relationships to the decedent and residence addresses of the
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`persons entitled to receive the property of the decedent as surviving spouse, heirs or devisees
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`of decedent's Will are:
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`Name
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`Robin K. Scholl
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`Age
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`Adult
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`Relationship
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`Residence Address
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`Son
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`1146 Pebblecreek Drive
`Mountain Home, AR 72653
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`THEREFORE, the above named distributee of this estate shall be entitled to distribution
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`of the property identified above, without the necessity of an Order of the Court or other
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`proceeding, upon furnishing a copy of this Affidavit, certified by the Clerk, to any person owing
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`any money, having custody of any property, or acting as registrar or transfer agent of any
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`evidence of interest, indebtedness, property or right of the decedent.
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`DATED this 16th day of October, 2014.
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`mkw
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`ROBIN K. SCHOLL
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`SS:
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`) )
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`STATE OF ARKANSAS
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`COUNTY OF BAXTER
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`Comes Robin K. Scholl, petitioner herein, and states on oath that the facts contained in
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`the foregoing Affidavit are true and correct to the best of his knowledge, information and belief.
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`Wei/We”
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`ROBIN K. SCHOLL
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`Subscribed and sworn to before me this 16th day of October, 2014.
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`KWlJfl-k
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`Notary Public
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`The undersigned Clerk of the Circuit Court of Baxter County, Arkansas, certifies that the
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`foregoing is a true copy of an Affidavit filed in this Court on the 16th day of October, 2014, that
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`the same remains on file and that no petition for the appointment of a personal representative
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`of the estate described in the caption has been filed in this Court.
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`DATED this 16th day of October, 2014.
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