HomeMy WebLinkAbout909635The State of Wyoming )
: SS.
County of Sweetwater )
AFFIDAVIT FOR DISTRIBUTION WITHOUT PROBATE
RECEIVED 6/30/2005 at 2:34 PM
RECEIVING # 909635
BOOK: 589 PAGE: 858
JEANNE WAGNER
LINCOLN COU ~TY CLERK, KEMME :~ER, VVY
COMES NOW Leslie Burris, of legal age, and after having
been duly sworn upon her oath, deposes and says as follows:
1. Diane Atwood, also known as Diane Lynn Atwood, died on
May 12, 2005 at Kemmerer, Lincoln County, Wyoming. At the time of
her death she was 62 years of age, was a resident of the State of
Wyoming and resided at 16 Gomer Street, Kemmerer, Lincoln County,
Wyoming. Affiant is the daughter of the decedent and makes this
Affidavit For Distribution Without Probate by and on behalf of the
below-named distributees.
2. The value of decedent's entire probatable estate,
wherever located, less liens and encumbrances, does not exceed
$150,000.00.
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decedent.
More than thirty days have elapsed since the death of
4. No application for the appointment of a personal
representative is pending or has been granted in any jurisdiction.
5. Decedent died without a will. The individuals named
hereinbelow are the surviving children of decedent and are the sole
heirs of the d~edent under Wyoming's laws of descent and
distribu'tion. There are no other distributees of the decedent
having a right to succeed to the property under probate proceedings
or under the laws of descent and distribution in the State of
Wyoming or any other state:
a. Robin Smith, of legal age, daughter, 9826 NE 140th
Street, Bothell, Washington 98011, 33-1/3% of estate;
b. Tiffany Atwood, of legal age, daughter, 7017 144th
St. SE, Snohomish, Washington 98296; 33-1/3% of estate;
and
c. Leslie Burris, of legal age, daughter, Box 829,
Kemmerer, Wyoming 83101, 33-1/3% of estate.
The above-named distributees are entitled to payment or
delivery of all accounts receivable and property which belonged to
the decedent.
6. Ail tangible personal property, including but not
limited to that stock specifically named below, authorized by
Wyoming Statute ~2-1-201 to be distributed by affidavit shall be
made payable and/or delivered and/or set over 33-1/3% to Robin
Smith, 33-1/3% to Tiffany Atwood; and 33-1/3% to Leslie Burris.
Said stock is more particularly described as follows:
83.335 shares of stock in T B R Constructors, Inc.
7. Any person or institution transferring property of the
decedent in accordance with this affidavit shall be held harmless
and a receipt from any distributee is a valid and sufficient
release and discharge for any such person or institution in regard
to transferred property.
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... :',n859
This affidavit is made in compliance with W.S. 2-1-201.
9. A certified copy of the Certificate Of Death is attached
hereto and by this reference made a part hereof.
DATED this
day o~ ~ __, 2005.
.) /'~ .-
County of
ss.
The forgoing Affidavit For Distribution Without Probate was
subscribed and sworn to before me this ~_~_~_ day of
_.~ , 2005, by Leslie Burris.
Witness my hand and official seal.
My Commission Expires:
-2-
· , .. ;!il,,::, :, .-. · ' -
"09o963 - .STATE OF....,:WYOMING
DEPARTMeNt':OF H;EALTIFI :: '~ :: ::?:' .~ ;,~,i' ;::!i '?~
2005_n 5.00
' ' ':':' ":': ........ :~ ~EPk'~TMENT ~'~ H~'~TH ..... -::~? %~ .............
LOC~ FILE NUMaER 1015 CERTIFICATE OF DEATH STATE FILE NUMBER
South Lincoln Medical Center ~- ¢- -.~ ,,%r~,: .: -., Kcmmerer ~? ,. ,
Lincoln
BYe, ~ ..... Wyominn. :' ? ' '.," F E nco n .... .,; . ¢,,,s ~ D amondv e' "
This is a true and exact reproduction of the aocument on file in the office of Vital
Records Services. -.:... ,-..Cheyenne'- Wyoming. ...,,.: ..... .,j
DATE:iSSUED: ::.. MAY~::.. 2' 5 ;7 2005:~: ~:~ ::?~:i ~iil . ..?~ ;?' '''~ ;~: ............ :;' ':~::'
::i:.. Luci~aa DIcC~re~! ~i!
Deputy Slate Reg~slrar
This copy is not valid u~Jess prepared on paper with an engraved border displaying the date, seal and signalurc oFthe Dcpu y £laL¢ ~.egisLrar