HomeMy WebLinkAbout920879
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COC640
WYOMING AFFIDAVIT OF COLLECTION OF ESTATE ASSETS
In accordance with Wyo. Stat. Ann. §§ 2-1-201 and 2-1-202
STATE OF WYOMING
ss,
COUNTY OF LINCOLN
I, Jac Milton Horton, the undersigned, first being duly sworn upon oath, state:
1. The following named individuals are the claiming successors of the decedent because
they are all of the children of the decedent:
Jac Milton Horton
Jon Robert Horton
Patricia Joy Horton Potter
Beatrice Ann Horton Burns
3,
Date of death:
June 5, 2006,
RECEIVED 8/2/2006 at 3:33 PM
RECEIVING # 920879
BOOK: 628 PAGE: 640
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
2.
Name of the decedent: Elaine Horton,
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4, State of decedent's residence at date of death: Wyoming,
5. Place of death: Afton, Lincoln County, Wyoming,
6. The value of the entire estate, wherever located, less liens and encumbrances, does not
exceed $150,000,00,
7, At least thirty (30) days have elapsed since the death of the decedent as shown in a
certified or authenticated copy of the decedent's death certificate attached to the
affidavit.
8. There are no other distributees of the decedent having a right to succeed to the property
under probate proceedings,
9, No application or petition for the appointment of a personal representative is pending or
has been granted in any jurisdiction,
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10, The individuals named in paragraph 1 above are entitled by law to payment or delivery
of the property, and I request that the following described property be paid, delivered, or
transferred to them in equal shares: Account No, 371-0359393 funds,
11, All statements in this affidavit are true and correct, and I acknowledge that any false
statement may subject the person or persons herein claiming to penalties relating to
perjury under the laws of the State of Wyoming and any other applicable law.
EXECUTED as of this 31st day of July, 2006,
--_ø~..~_.
Ja Milton Horton
o Box 264
Afton, WY 83110
Subscribed and sworn to before me by Jac Milton Horton this 31 st day of July, 2006.
Witness my hand and official seal.
GE~LD L, GOUlDING- NOTARY PUBLIC
County ot Al\ State ,of
Uncoln V Wypmlng
My Commlssìon Expires May 2, 2007
NOTARY PUBLIC
My commission expires: May 2, 2007,
2
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