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Home My WebLink About936677 IN THE DISTRICT COURT OF THE THIRD JUDICIAL DISTRICT úOð530 IN AND FOR THE COUNTY OF LINCOLN, STATE OF WYOMING IN THE MATTER OF DETERMINATION OF HEIRSHIP OF ) ) KATHLEEN ROSAS, Deceased. ) ) ) Probate No. AFFIDAVIT FOR DISTRIBUTION OF ESTATE STATE OF WYOMING ) ) ss. COUNTY OF LINCOLN ) I, John R. Rosas, being first duly sworn, on oath deposes and states as follows: 1. That I am over the age of twenty-one (21) years. 2. That Kathleen Rosas is my wife. 3. That my wife, Kathleen Rosas died on the 21 st day of November, 2007 in the City of Salt Lake, County of Salt Lake, State of Utah. 4. That my wife, Kathleen Rosas did not have a Will upon her death and accordingly died intestate. 5. That the heirs of Kathleen Rosas are John R. Rosas, Michael P. Rosas, and Jonathan D. Rosas. 6. That Michael P. Rosas and Jonathan D. Rosas have disclaimed any interest in the property of the Kathleen Rosas Estate and agree that the property in said estate shall be distributed as though they did not survive Kathleen Rosas as is shown by the Disclaimers of Interest in Property of Michael P. Rosas and Jonathan D. Rosas attached hereto. 7. That the value of the entire estate of Kathleen Rosas, wherever located, does not exceed one hundred fifty thousand dollars ($150,000). 8. That thirty (30) days have elapsed since the date ofthe death of Kathleen Rosas. 9. That no application for appointment of a personal representative is pending or has been granted in any jurisdiction regarding Kathleen Rosas. 10. That I am entitled to the payment or delivery of the property of Kathleen Rosas and there are no other distributees ofthe Decedent having a right to succeed to the property under probate proceedings. RECEIVED 2/4/2008 at 8:30 AM RECEIVING # 936677 BOOK: 685 PAGE: 530 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY Probate\Rosas\AfIidavit of Distribution 11. That the personal property owned by Kathleen Rosas is as follows: vOû531. a. 2006 Subaru Tribeca; VIN #4S4WX83C464402398 b. 1997 Arctic Cat Snowmobile; VIN #9731402 c. Account #10065308 at 1 st Bank in Kemmerer, Wyoming 12. That if any other personal property is located that is not identified above, I am entitled to that property. Dated this 30 day of ~ ~'-I\. ,2008. ~~ f-- ~~ JOHN R. ROSAS STATE OF WYOMING ) ) ss. COUNTY OF LINCOLN ) I, John R. Rosas, being first duly sworn, states that I am the affiant noted above, that I have read the same, know the contents thereof, and that the statements contained therein are true. J0l\ [Wø~ JOHN R. ROSAS Subscribed and sworn before me this 30 {J, day of f /Im uall! ,2008. t"ÕÊßf~>A·A.~:;SIi!.~A.qTI;ÚDr'êl t COUNTY OF ð~'\¡':':l SWEDF >, ~ LI'!C~I "¡ It ".;' ,"" "II.'fI:,,~:"'':' t. ~ I. UU ,.:\~~-,~:", ,,, "".., ,... i: · . ~~"""('SIG" ~ìí~""~S ~.., ~':.;:,~;';:~~..;':~ .~: .:;~ I .i9o.b/)(L () lIofY1.t.\(!,YLJ NOTARY PUBLIC My Commission Expires: :;/:71/:JLJ/ / Probate\Rosas\AfIidavit of Distribution 2 :1.. 'fI .'i!' -, II' " \ 1"i i"Irn~- CERTIFICATE OF DEATH State File Number: 2007012926 000553 ..--- " Kathleen Rosas . ÜOiÞ532 DECEDENT INFORMATION Date of Death: City of Death: Age: . Place of Birth: Armed Services: Spouse's Name: \ Ihdustry/Business: Residence: Mother's Name: Facility or Address: November 21, 2007 Salt Lake City 53 '- Kemmerer. Wyoming- No John R Rosas ' Domestic Diamondville, Wyoming Jewell Lorraine Mills University of Utah Hospital '-, \ Time of Deatlí: County of Death: Date of Birth: Sex: Marital Status: Usual Occupation: Education: Father's Name: Facility Type: 00:12 Salt Lake August 31, 1954 Female Married Homemaker Some College but No Qegree Robert H Krall Hospital Inpatient INFORMANT INFORMATION" ',. Name: '- John R Rosas ,d' .' RelatiQnship::' , Mailing Address: 20 Little Cany~n R~ad, Diamondville, Wyoming 8~16 " . 1.~~ /':..\~~i:-~· '. ,",~ÙSba~~~';i' \ ..,.., ;. '. 'Or: ; ;.1'.';. DISPOSITION INFORMATION ,',' , ,; , '_... Method of Disposition: Cremati~n.", . ~",,:i'-·,:pate9!"Dispositìon:·Nc>vembêr"2"l;·2007 Place of Disposition: Utah l=.üneràfDirectörs Cremation C~l'1t!'Jr,SouthJordan, Utah',';;:i\ ',.",.,. "'¿:,;,':. FUNERAL HOME INFORMATI~~" . ,.,' ",'::,,::::;' 't:(i.:'Yj~rl,'~.~·;i""·<:~'h'·" ' Funeral Home: OtancfallFûneral Home:.~.." . . ~ ..'~' :";"'~' ~;~.~~:~~~>'... ,"!.'--. Address: PÒ Box 6, 105 EastCeriterStreet, (amas,.l)tahß4036 Funeral Director: }Nilliam:.W Ball ';"':;:~' '?:.... -"C!"""'i"",,,.~:..,,:,<.)' i.: ;', ., .:.,E"· MEDICAL CERTIFICATION . :e'i;'.";,,, ,.',;i\ .,,' ,.",., ~;';::' "c';.,.. "~', Certifying Physician:.JasQn.Schwartz MD, 50 North'Medical Drive, SaltLaké;'Citý,.;~alt LakeCity-.J..Jta~J3,4132 CAUSE OF DEATH '\:.:', ".:'; ,;'{ ,. .' .... "")'";:;,::, ":'::,f"'::" \ 2:;' 'A.'; i~~~ Fulminant hepatic failure [Ònset: 7 Days] ""c' :~;' ~'j~ .,....,.,',:,.',.,,\.:,},:.,~: Malnutrition ,::":",,,,.,,< ,. j; .",,; " ~~~~~~~E~:~iner Contac~~~Ñ6:\!X~:=~y Perfor~ed~Y ~:SAU;~P!>Y'~V~¡I;~~¡:';~~S' MannE!rof DèàtH;'~atural "':::-",- .,~,..::" ,,":" '". ':. '.~"'~( .~, .:.-' . ,,, ", '.:~: .' ~. , " ,>.::, /.';"", .'.. {.:.'..;,.,."'.','~:'.,~".;>~: . .i.~}:._ ..,.~;;;.' " ,_', "-'.;:~~: ;. ., '.:"~', " "::i. . " ,,-..- /i"., .., " November 26, 2007 \ \ This is an exact reproduction of the ~ocument registered in the State Office of Vital Statistics. Security features of this official documentdnclude: Intaglio Border, V & R Images In top cyclolds, ultra violet fibers and hologram image of tll'e Utah-State Seal, over the words "State of Utah". This document displays the date, seal and signature of the State Registrar and the County/District Health Officer. &d~ Director/Health Onlcer CountylDlstrlcf Health Department ~ê/~ Barry E. Nangle, State Registrar Office of Vital Statistics' 11~1I11~1111I1I1~lllIllIlIllllmllllllll~ ~II *06J.547336* DISCLAIMER OF INTEREST IN PROPERTY ûOv533 I, MICHAEL P. ROSAS of 1989 East Pheasant Way, Holladay, Utah hereby disclaim for myself and my heirs, legatees, devisees, and legal representatives, any and all claims on my part to any ofthe property in the estate of my mother, Kathleen Rosas, deceased; specifically, the following property: 2006 Subaru Tribeca; VIN #4S4WX83C464402398 1997 Arctic Cat Snowmobile; VIN #9731402 I further disclaim and renounce that these items or any portion thereof belong to me nor should they be left to me by any last will of the deceased. I further disclaim and renounce any interest in or right thereto even under the intestacy statutes of the State of Wyoming. I hereby agree for myself and my heirs, legatees, devisees, and legal representatives that the property described above and any other personal property that is discovered after I execute this disclaimer and deemed to belong to my dear mother, the said deceased, that property shall be distributed in accord with the Wyoming intestacy statutes and shall go to my father, John R. Rosas. This disclaimer is made pursuant to §§ 2-1-401 through 404 W.S. (Lexis 2001) with the intent being that I hereby in writing and irrevocably, without qualification refuse to accept any interest in said property and accordingly, am aware that my disclaimed interest would pass as though I did not survive my dear mother, Kathleen Rosas and go directly to my father, John R. Rosas. Dated this ~ day of U tww.o ~l .2008. ~Æ~ MICHAEL P. ROSAS ) )ss. COUNTY 0 ) Subscribed and sworn before me thisdt; "6day of Michael P. Rosas. 2008 by DISCLAIMER OF INTEREST IN PROPERTY Üt00534 I, JONATHAN D. ROSAS of 602 East 5 th Street, Chadron, Nebraska hereby disclaim for myself and my heirs, legatees, devisees, and legal representatives, any and all claims on my part to any of the property in the estate of my mother, Kathleen Rosas, deceased; specifically, the following property: 2006 Subaru Tribeca; VIN #4S4WX83C464402398 1997 Arctic Cat Snowmobile; VIN #9731402 I further disclaim and renounce that these items or any portion thereof belong to me nor should they be left to me by any last will of the deceased. I further disclaim and renounce any interest in or right thereto even under the intestacy statutes of the State of Wyoming. I hereby agree for myself and my heirs, legatees, devisees, and legal representatives that the property described above and any other personal property that is discovered after I execute this disclaimer and deemed to belong to my dear mother, the said deceased, that property ~hall be distributed in accord with the Wyoming intestacy statutes and shall go to my father, John R. Rosas. This disclaimer is made pursuant to §§ 2-1-401 through 404 W.S. (Lexis 2001) with the intent being that I hereby in writing and irrevocably, without qualification refuse to accept any interest in said property and accordingly, am aware that my disclaimed interest would pass as though I did not survive my dear mother, Kathleen Rosas and go directly to my father, John R. Rosas. Dated this ~ day of :-)~~ u. 0...." I ,2008. STATE OF NEBRASKA ) 1'\ )ss. COUNTY OF J.. )(ì II P So ) (;{ Subscribed and sworn before me this ~ day of Ja A"\i In ':-r.J Jonathan D. Rosas. ~ , 2008 by '--P1Cl~ fl A~ NOTARYP LI My Commission Expires: q- ;;){/ 00 I 0 ~,"~~V'~:·.... ~'ft~:~, ":;:; : '.':\ ..,' . \{~,>,:.::. r ' ~:t :,~~'I ~'. .:~' '·~t)([ . i,1 :."!MI8SI0~" ::XPIRES ':c:;1!OO1bet 24, 2010 -.,.,-. .-. '.';iP:U?: ..