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000601
AFFIDAVIT OF SURVIVORSHIP
THIS AFFIDAVIT is made pursuant to W.S. § 2-1-201 by Robert E.
Beutler, Jr. and Laura M. Kaiser, who, being first duly sworn and upon their oath,
state as follows:
1. We are the only children of Robert E, Beutler, Sr. who died
intestate on December 2, 2006, in Kemmerer, Lincoln County,
Wyoming.
2. At the time of his death Robert E. Beutler, Sr. was a resident of
Lincoln County, Wyoming,
3. We are the sole heirs and distributees of Robert E. Beutler, Sr., and
there are no other heirs or distributees having a right to succeed to
the property of Robert E. Beutler, Sr.
4, The value of the entire estate of Robert E. Beutler, Sr., wherever
located, less liens and encumbrances, does not exceed One
hundred fifty thousand dollars ($150,000,00).
5. Thirty (30) days have lapsed since the death of Robert E. Beutler,
Sr.
6. No application for appointment of a personal representative is
pending or has been granted in any jurisdiction.
7. As claiming distributees, we are entitled to payment or delivery of
any tangible personal property of Robert E. Beutler, Sr., including
stocks, bonds and any deposits held by any bank, savings and loan
Page 1 of 3
RECEIVED 2/26/2007 at 10:05 AM
RECEIVING # 927018
BOOK: 649 PAGE: 601
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0927018
000602
institution, credit union, asset management service, or like
depository .
~~.~~
Robert E. Beutler, Jr. ~
fJLUt(J.. n.!. ¢1ùa~
aune m. Kaiser
STATE OF WYOMING )
) ss.
County of Lincoln )
The undersigned ROBERT E. BEUTLER, JR., being first duly sworn,
states that he has read the foregoing Application and hereby affirms the
same as the truth, to the best of his knowledge and belief.
aM-G.a~
Robert E. Beutler, Jr.
ROBERT E. BEUTLER, JR., personally known to me did appear
before me and, upon being duly swornQÎersonallY did si n the foregOing.
document and verification thereof this ( day of l ) ,
2007. )
"
Witness my hand and official seal.
My Commission Expires: ;) (~.- JO
~
Page 2 of 3
0927018
000603
STATE OF WYOMING )
) 55.
County of Lincoln )
The undersigned LAURIE M. KAISER, being first duly sworn, states
that he has read the foregoing Application and hereby affirms the same as
the truth, to the best of his knowledge and belief.
~ ð·
, . lil.AC{ m. . ÍUl!I1
Lau Ie M. Kaiser
LAURIE M, KAISER, personally known to me did appear before me
and, upon being duly sworn,~ersonally did si n the foregoing document
and verification thereof this (r;)U day of . \D , 2007.
Witness my hand and official seal.
My Commission Expires: ;)-L?'y (Ö
Page 3 of 3
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