HomeMy WebLinkAbout918508
C00410
AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF
DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2-1-201
: ss.
RECEIVED 5/17/2006 at 4:42 PM
RECEIVING # 918508
BOOK: 620 PAGE: 410
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING
COUNTY OF LINCOLN
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I, C. Davis Leavitt, being first duly s~om, on oath depose and state that I am making this
affidavit pursuant to W.S. 2-l-201, on behalf of myself as sole distributee, as hereinafter set
forth, and that I make the following statements in connection therewith:
1. That LaVar Barnes Leavitt aka LaVar B. Leavitt aka LaVar Leavitt became deceased
on January 11, 2006 in Afton, Lincoln County, State of Wyoming; that said decedent was a
resident of Afton, Lincoln County, Wyoming, at the time of his death; that said decedent died
intestate; that I am the father and only heir of the decedent; and that I am the sole and only party
entitled to the estate of the decedent in accordance with the laws of the State of Wyoming.
2. That the value of the entire estate of said decedent; wherever located, does not exceed
$l50,000.00.
3. That more than thirty (30) days have elapsed since the date of death of decedent.
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I, :.-. 4. That no application for the appointment of a personal representative of said decedent is
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pending or has been granted in any jurisdiction.
5. That the following named distributee is the sole and 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 under probate proceedings; and that therefore the following named claiming
distributee is entitled to payment or delivery of all of decedent's property.
Name
C. Davis Leavitt
Relationship
Father
6. That among the assets owned by said decedent were the following:
Residence
Modified mobile home located at T32R119S2l NW 4NE4.
GEO PIN: 3219-21-1-00-012-40
Tax District: 0211
The above property should be transferred to the undersigned.
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09'l8508
C00411
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 ofthis 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 11 th day of May, 2006.
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. C. Davis Leavitt
Subscribed and sworn to before me by C. Davis Leavitt. this I (Æ-hr day of May, 2006.
Witness my hand and official seal.
ANGIE PUTNAU . NOTARY Ft8.IC
COUNTY OF _ STATea:
LINCOLN _ MtIIJiB
? MY COMMISSION EXPÆS sePT. 8._
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NO~YPUBLIC-
My commission expires: September 9, 2009
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