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RECEIVED 2/24/2006 at 1 :32 PM
RECEIVING # 916219
BOOK: 613 PAGE: 87
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
C00087
\1
AFFIDAVIT,OF COLLECTION AND DISTRIBUTION OF
DECEDENT'S PERSONAL PROPERTY
The undersigned, being first duly sworn, on oath depose and
state that we are making this affidavit pursuant to Section
2-1-201, Wyoming Statutes Annotated (2005), on behalf of ourselves
as distributees, and that we make the following statements in
connection herewith:
1. That Ronald W. Sax died on September 27, 2005, in Napa
County, California, and was a resident of Lincoln County,
State of Wyoming, at the time of his death; that said
decedent died intestate; that we are the sole and only
parties entitled to the property of the decedent pursuant
to the laws of the State of Wyoming.
2.
That the value of the entire estate
administration wherever located, less
encumbrances, does not exceed $150,000.00.
subject to
liens and
3. That more than thirty (30) days have elapsed since the
date of death of the decedent.
4. That no application Or petition for the appointment of a
personal representative of said decedent is pending or
has been granted in any jurisdiction.
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0316213
C00088
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5. That the only personal property owned solely by said
decedent not otherwise disposed of is the following:
2004 polaris ATV (VIN 4XACH50A5A343633)
6. The undersigned request that the title to the above-
mentioned vehicle be transferred to Brandon Keith Sax.
DATED as of this t 9-ht day of ~b r- '-LA t' '1
, 2006.
BRANDON KEITH SAX
STATE OF CALIFORNIA
COUNTY OF ~
ss.
day
Ther~oregoing instrument was acknowledged before me this (?~
of J-d/.f'!A.A"'1' ,2006, by Wayne Neil Sax. St'e õ1fC1-c1e.J....
WITNESS J hand and official seal.~ (}, ~_
Notary Public
My Commission Expires:
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0916219 ~00089
Ca. (¡ b~ IÅ-
STATE OF-oIt.I1.\,jUN '~)
M ) SS.
COUNTY OF ~ )
day
Th~~oregoing instrument was acknowledged before me this l~
of l-€Íb r tt ð r' 7' I 2006 I by Rhonda Deann Sax. .c;eg¿ ~ ~
WITNESS my hand and official S]k (j ( ~'</I.-.,
Notary Public
My Co~mission Expires:
/ t-¿7 (- 2-d7J 0
STATE OF CALIFORNIA J
^ L, 111 a. ' ) ss .
COUNTY OF ~ )
day
T~dfOregOing inst~ument was acknowledged before me this (c1~
ofE-~ '('v.....t.~f'.( , I 2006, by Brandon Keith Sax. ~ee.cx-~~
WITNESS my hand and official SïJ¿~ t1,;Ø-L-_______
otary Public
My Commission Expires:
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091.G219 CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of
(JA
tV ~p ðo-
,
)
)
County of
00090
On ð;l. ~ (q... fìðO b before me,
(Ú'~OJ\~ 11. MI\-1S~ ¡)Jðtaf
f vi (/ c
(here insert name and title of the officer)
<;;a..X
WOJ-{ /11 e. ¡\j e: l ~ ClX (3 r~etð\1 k e l+4 ç Q)<
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
personally appeared
R~D~i ~
Ð é''l V\. V\.
1
I
WITNESS my hand and official seal.
~ r1,~~
Signature of Notary Public
.
(Seal)
.
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document, The only exception is if a
document is to be recorded outside of California. In such instances. any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal/or a notmy in
California (i.e. certifying the authorized capacity 0/ the signel~. Please check the
document care/u!!y /01' proper notarial wording and attach this/orm ifrequired.
DESCRIPTION OF THE A TT ACHED DOCUMENT
Dl5 tr: \, lc~<\ !.Ì
(Title or desc~i~ion of altached document)
ç-. 'V 0(' ~ V' -'c.
(Tille or description of altached document ontinued)
Number of Pages ì Document Dateð l. -I1-ð 6
A({.<lM¡t o-Ç
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
<t:::k:1ndlvidual (s)
TI COrÞorate Officer
(Title)
o Partner(s)
o Attorney-in-Fact
o Trustee(s)
o Other
CAPAvI2.IO.05 0 by Association of Professional Notaríes & CSA 800-873-9865 www.not8!}'classescom
· State and County information must be the Stale and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
· Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed,
. The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
· Print the name(s) of document signer(s} who personally appear at the time of
notarization,
. Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
M/she/they, is fare ) or circling the correct forms. Failure to correctly indicate this
infonnation may lead to rejection of document recording.
· The notary seal impression must be clear and photograph ically reproducible.
Impression must not cover text or lines. If seal impression smudges, re-seal if a
sufficient area permits, otherwise complete a differenl acknowledgment form,
· Signature of the notary public must match the signature on file with the office ot
the county clerk.
... Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
.:. Indicate title or type of attached document, number of pages and date.
.:. Indicate the capacity claimed by the signer. If Ihe claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO. Secretary).
· Securely attach this document to the signed document
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