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STATE OF WYOMING
AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF
DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2-1-201
RECEIVED 1/16/2006 at 10:18 AM
RECEIVING # 915237
BOOK: 609 PAGE: 723
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER WY
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I. LaQuita Sklenar, being first duly sworn, ,on oath depose and state that I am making this
affidavit pursuant to W.S. 2-1-201, in behalf of myself as the heir at law and distributee. as
hereinafter set forth, and that I make the following statements in connection therewith:
ss.
COUNTY OF LINCOLN
1. That Joseph Sklenar aka Joe Sklenar became deceased on October 18, 2005, in
Idaho Falls, Bonneville County, State of Idaho and was a resident of Afton, Lincoln
County. Wyoming, at the time of his death; that said decedent died intestate; that I am
the surviving spouse of the decedent; that the individual listed in Paragraph 5 below is
the only party entitled to the estate of the decedent in accordance with the laws of the
State of Wyoming.
2. Thánhe value of the entire estate of said decedent, wherever located, does not exceed
$150,000.00.
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3. That more than thirty (30) days have elapsed since the date of death of the decedent.
4. That no application for the appointment of a personal representative of said decedent is
pending or has been granted in any jurisdiction.
5. The following named distributee is the only party entitled to the estate of the decedent;
that there are no other distributees of the decedent having a right to succeed to any of
the property of the decedent under probate proceedings; and that therefore the following
named claiming distributee is entitled to payment or delivery of all of decedent's
property:
Name
, ,
LaQùitá Sklénar
Relationship
Spouse .'
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6. That among the assets owned by said decedent were the following:
37 shares of American Family Corporation, Certificate No. G29639.
7 shares of American Family Corporation. Certificate No. G32665.
44 shares of AFLAC Incorporated, Certificate No. A1093333.
88 shares of AFLAC Incorporated, Certificate No. A1137349.
All shares of AFLAC Incorporated held in Account No. 3000046901.
That all of the shares listed above are now due and payable to the distributee
named above.
7. That attached hereto and incorporated herein by this reference is a certified copy of the
death certificate for the decedent.
8. That the original of this affidavit is being filed of record in the office of the County Clerk
of Lincoln County, Wyoming, in compliance with W.S. 2-1-201 (c), as amended.
EXECUTED as of this 11th day of January, 2006.
c~~~
LaQuita Sklenar
Subscribed and sworn to before me by LaQuita Sklenar, this 1.2+h day of January, 2006.
Witness my hand and official seal.
GERÁLDL. GOUlDING· NOTARY 'PUBLIC
, COUf'lty,· of A State of
UnCoIn 'IJìi Wyºming
Mï Commlsslon expires May 2. ~OO7
~~~
NOTARY PUBLIC ,'. .
My commission expires: May 2,2007.
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