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Home My WebLink About928128 AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2-1-201 Michaela R. Kaumo, Pamela A. Anderson and Paul J. Taucher, being first duly sworn according to law, upon their oaths depose and say: 1. That Nelson E. Taucher died intestate at Idaho Falls, State of Idaho, on February 10,2007. 2. That at the time of his death, Nelson E. Taucher was domiciled in the State of Wyoming, County of Lincoln. 3. That at the time of his death, said Nelson E. Taucher left surviving him the following named persons who would have, under probate proceedings, the right to succeed to the property of said Nelson E. Taucher. Name. Address and Relationship Age Share of Estate Michaela R. Kaumo, Sister 1401 Edgar Street Rock Springs, WY 82901 Legal 1/3 Pamela A. Anderson, Sister 2045 Skyview Rock Springs WY 82901 Legal 1/3 Paul J. Taucher, Brother 2302 Nighthawk Laramie WY 82070 Legal 1/3 4. That at the time of his death, Nelson E. Taucher was the owner of the following-described personal property: (a) One (1) 1969 OLDS 2DSDN, VIN 394879M624688, Registered under Wyoming Certificate of Title No. 12-0179214; (b) One (1) 1996 HD SOLO VIN IHDIDJLI8TY615595, Registered under Wyoming Certificate of Title No. 04-0493509; (c) One Shoreland'rUtilityTrailerVIN IMDFRBG13YA104453, with Montana Certificate of Origin for a Vehicle number 00982041; (d) Qwest Savings Plan Account number 520660574; (e) The Bank of Star Valley Checking Account No. 11542396; (f) One (1) 2006 Dodge PU, VIN 3D7KS28C56G290792, Registered under Wyoming Certificate of Title No. 12-0237245; and (g) One (1) 2006 KODIK TV VIN 47CTS5M216L115843, Registered under Arizona Certificate of Title No. 00J100G 164020 RECEIVED 4/5/2007 at 9:39 AM RECEIVING # 928128 BOOK: 653 PAGE: 437 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 0928128 000438 5. That the value of the entire estate, wherever located, less liens and encumbrances, does not exceed One Hundred Fifty Thousand and NollOO Dollars ($150,000.00). 6. That thirty (30) days have elapsed since the death of the decedent. 7. That no application for appointment of a Personal Representative is pending or has been granted in any jurisdiction. 8. That the above-named distributees are entitled to payment or delivery of the property of said decedents; and there are no other distributees of the decedents having a right to succeed to the property under probate proceedings. 9. That affiants as the surviving heirs-at-Iaw ofthe decedent herein, state that the above-named heirs are entitled to have the above-described personal property by virtue of and have executed and filed this affidavit pursuant to the provisions of Wyoming Statutes Annotated, Section 2-1-201 (Lexis 2005), and that the Certificate of Death, hereunto annexed and by this reference made a part hereof, is a certified copy of the Certificate of Death of said decedent, Nelson E. Taucher. DATED this '22- Vld day of March, 2007. "aAØo;'A '¿-P;;L~~ Michaela R. Kaumo ¿d, .I. Pamela A. Anderson £µ/¿rnJ v- ¡J þ~/,t-- j/ ~C'- V/U<e-,/ Paul J. Taucher - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THE STATE OF WYOMING ) : ss. COUNTY OF SWEETWATER ) The foregoing Affidavit for Collection and Distribution of Decedent's Personal Property Pursuant to W.S. 2-1-201 was acknowledged before me by Michaela R. Kaumo on this Î~:V"l~ay of March, 2007. WITNESS my hand and official seal. ~~ Not~ Publ~ . v My Commission Expires: \Ö'~ 10 V' \0 -- JAN A. LEVITT . NOTARY PUBLIC COUNTYOF _ STATE OF SWEETWATER W' WYOMING MY COMMISSION EXPIRES OCTOBER 10. 2010 09281.~8 THE STATE OF WYOMING ) : ss. COUNTY OF SWEETWATER ) 000439 The foregoing Affidavit for Collection and Distribution of Decedent's Personal Property P'lrsuant to W.S. 2-1-201 was acknowledged before me by Pamela A. Anderson on this 2-1r',ctlay of March, 2007. 'AI .. JAN A. LEVITT -:. NOTARY PUB(fC COUNTYOF & STATE Of SWEETWATER., WYOMING MY COMMISSION EXPIRES OCTOBER 10, 2010 nd and official seal. My Commission Expires: tL) ~IL\'-'IÖ Notary - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THE STATE OF WYOMING ) : ss. COUNTY OF ALBANY ) The foregoing Affidavit for Collection and Distribution of Decedent's Personal Prope~y Pursuant to W.S. 2-1-201 was acknowledged before me by Paul J. Taucher on this 2'éél" day of March, 2007. WITNESS my hand and official seal. . KERRY LUCK-NOTARY PUBLIC County of ,.& State of Albany . Wyoming My Commission Expires Aug. 3, 2009 I :7 ¡~- NO~ ¿ - ß/ 3/ () q ( { My Commission Expires: ¡f1l~~S1Z8 ."_" 'Y.. _.__.. __., __.. , _'._., _ STATE OF IDAHO IDAHO DEPARTMENT OF HEALTH AND WELFARE BUREAU OF HEALTH POLICY AND VITAL STATISTICS ¡~ I I I ~ ~ I I ~ I I I '~ I ~ "~ ~ I nI"l OR 'RINTIN 'tAMANINT BlACK INK 00 HOTUSI FELT TIP ,eN '00 INSTRUCOONI ... HAHOBOOKI _II.::I..U::II::IUII! F OEATH WAS DUE TO OTH!,. THotHNA'URAt. CAUIU. THE CORONI!Jt IWJI CON'LETE AND 'IOHTH! crRfFICA'! DATE FILED BY STATE REGISTRAR: Slale of Idaho CERTIFICATE OF DEATH /2-4- ì t I I I I I ~ . ~ I I ~, ~ I ~ I , I ~ ~¡ I ~ . J ø STATE FilE NO. OM.::~'::~T:.:u.~;-::.~E=~:' ~~:o,r::.~~:U::'~4~~~:':::'~'::~ME, Local Reg. No. * 1. DECEDENTS LEGAL NAME (Indude AKA', II any) (Flr¡I, Middle, lesl, Suffix) 3. SOCIAL SECURJTY NUMBER February 27. 1955 Salt Lake City, Utah _ Wyoming ~ 1d. STREET ANO NUMBER > ~ Highway 89 - 72297 Ž ~ .. MARITAL STATUS AT TIME OF DEATH ~ ~ 0 Married 0 Married. but separaled 0 Widowed H Divorced 0 Never tf'8nted 0 Unknown ~ ~ 10. EVER IN U.S. tho FATHER'S NAME (First, Middle, Lasl, Um)! 0: u: ARMEO o ~ FORCES? John Lewis Taucher :E ; 0 Yel 12., MOTHER'S MAIDEN NAME (Flrsl, Middle, lasl, Suffix) lii II No Maxine Faye Parkin ; -' ~ 13a,INFORMANT'S NAME (Type Of'prlnt) 13b, RELATIONSHIP TO DECEDENT " ~ Pamela A. Anderson Sister 8 ~ 1~~~THOD OF DI}{;~::I~on :~~:.~~ ~:e~~S::~~ITION (Name IInd øddress of cemelery, o eon.tlon 0 Enlomb.....nl Eagle Rock Crematory g ~~~~:;:'~.ho Idaho Falls, Idaho * 17.. SIGNA URE OF FUNERAl SERVICE LICENSEE OR PERSON ACTING AS SUCH Lincoln Smoot 71. ZIP CODE 11b. BIRTHPLACE (Slale. Terrilory, or Foreign Counlty) Rock Springs. Wyoming 12b. BiRTHPLACE (Stale, Tenttory, or Foreign Counlry) Powell, W omin 13c. MAILING ADDRESS (Slreel and Number, Clly, Slale, Zip Code) 2045 Skyview Street R !Xin~IL_Wvomin * 1.. NAM AND ~~ F FUNERAL FACILITY Wood Funeral Home 273 N. Ridge Ave., P.O. Box 51434 Idaho Falls, Idaho 83405-1434 1.. WAS CORONER CONTACTED'll DYes IJ No * 17b. LICENSE NUMBER (Of licensee) M-778 PLACE OF DEATH 19-22 * 111. IF DEATH OCCURRED IN A HOSPITAL: 1* 19b, IF DEATH OCCURRED SOMEWHERE OTHERTHAH A HOSPITAL: ,rXlnpallenl 20 ERIOutpallenl 10 DOA 1,0 Hospice faclllly .0 Nursing homellong 1em1 care faclllly .0 Decedenl's home ,0 Olher (Spectfy) * 20. FACILITY NAME (If mil 'aciUly, give slreeland number) * 21. CITV, TOWN, OR lOCATION OF DEATH, AND liP CODE * 22. COUNTY OF DEATH Eastern Idaho Regional . 23. DATE OF DEATH (MoIDaytYr (Spell month) Idaho Falls Bonneville 25, DATE PRONOUNCED DEAD (MoJDaylYr (Spell month) 28. TIME PRONOUNCED DEAD Februar 10, 2007 10 2007 (24hr) IMMEDIATE CAUSE (FInal.. disease CII" condlllon -+ resulting In dealh) Sequenllllly IIsl Conditions, b. If any, leldlng 10 the cause Ilsled on tIne e. Enler the = UNDERL YlNO CAUSE m LAST (dllease or Injufy ð Ihetlnltllled lhe evenls _ resuftlng In death) d. ., ~ PART II. Enler oIl-IhBl slonmfcanl condl(.uons conlrltpJUno IO,death bul no! resufUng In the underlying cause given In Part I 156 tf''' I( ¡"y-r-'-v/I/ _:I: IJ.. N 21, DID TOBACCO USE 30. IF FEMALE (AUld 10.54): r: ~ CONTRIBUTE TO DEATH? 0 Not pt"egnlnl wllhln pesl yeer ffi;s 0 Yes 0 Probably 0 Pregnenl 'I lime 01 dellh U ~ 0 Not pregnent, bul pregnanl .! (& No 0 Unknown wIlNn 42 days of death ~ 32. DATE OF INJURY (MoIOayIYr) 33, TIME OF INJURY E (SOON""'""! o U 31. LOCATION OF INJURY: Stale 1 ApproJdmale fnlefV8l: I Onlello Dealh : J J<\1r I I I I I I I c. 4 la- c¡ J"1f r ' 'j ""r f DUE TO lor.. . CIIn.~ueflC' 01)' 281, WAS AN AUTOPSY ,Zlb, WERE AUTOPSY FINDINGS PERFORMED? I AVAILABLE TO COMPLETE : THE CAUSE'OF DEATH? . 0 Ves D.No o Yes No 31. MAHNER OF DEATH Þ. Hahnl 0 Horridde o ^ccldent 0 Pending Invelllgøuon o Suicide 0 Could nol be delermlned o Hot pregnant. but pregnant 43 days 10 1 yeer before dealh o Unknown If pregnanl wllhln Ihe pasl ye., 34. PLACE OF INJURV (Decedent's home, larm, slreel, conslrucllon sile, nursing home, resløOtanl,lorest, elc.) 3S.INJURY AT WORK? o Ves D No CllyfTown or County ZIp Code Street Ind NulriJer or locallon Apar1ment Nurmer 37. DESCRIBE HOW INJURY 0 CURRED. IF TRANSPORTATION INJURV, STATE THE TYPEIS) OF VEHIClEIS) INVOLVED (Automobile, pickup, rrolorcyde, AN, bicycle, elc.) SPECIFY WHtcH VEHICLE DECEDENT OCCUPIED, If appllCllble TRANSPORTATION ,3111. WAS DECEDENT: DrivllrlOperøl()( Passenger tUb. WHAT SA~ETV DEVlCE(S DID DECEDENT USE/EMPLOY? INJURY ONLY' 0 Pedeslrian 0 Olher S eel' I 0 Seal bell 0 Child serely seat 0 Helmel 0 Air bag 0 None 0 Unknown JIa. CERTIFIER (Check only one, based on offictal capøclly for this certUlcate) 38 , B R XI PHYSICIAN ~ To Ihe besl of my knowtedge. death occurred al the lime, dale, and place, and due 10 the l!JJJlLI1 cause(s)lmanner slaled. "M- 612 3 o CORONER· On Ihe basis oIexaminøtlon aMlI)( Invesllgatlon,ln my opinIon. dealh OCCUfTed althellme, dale, and place, and due 10 Ihe nc. DATE SIGNED CIIuse(s)andrrennerstaled. ,/ Á· (,IJ. , /J... ,~ r t/- -s",; /flifr-A" - .1. MMOO yyyy Idaho 8 0 4Db. DATE SIGNED I I MMDD---Y:;YY- 41b, DATE SIGNED Ô2 d!LJ..2lirL MM DD YYYY ~"'\'\\\\\\\\\\"\I\" ,s,,,.r>"'I' '111"",. #' ;l ; , § Ii ~ I \ ~~" This Is a true and correct reproduction 01 the document olllclally registered iÌ"d placed on lIIe with the IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTlpS. i i~7~~7~ JANE.S. SMITH STATE REGISTRAR DATE ISSUED:f..plûru¿¡~ JL-h 7JJJ7 This copy not valid unless prepared engraved border displaying state seal and signature 01 the Registrar.