HomeMy WebLinkAbout938579
AFFIDA vir OF SURVIVORSHIP
000203
THIS AFFIDAVIT is made pursuant to W,S, § 2-1-201 by LARRY
OSTERKAMP and JEAN EDINGER, who, being first duly sworn and upon their
oath, state as follows:
1, We are the surviving siblings of Dale Harold Osterkamp who died
intestate on October 25, 2007, in Salt Lake City, Salt lake County,
Utah.
Lincoln County, Wyoming,
2, At the time of her death Dale Harold Osterkamp was a resident of
3, We are the sole heirs and distributees of Dale Harold Osterkamp,
and there are no other heirs or distributees having a right to
succeed to the property of Dale Harold Osterkamp,
4. The value of the entire estate of Dale Harold Osterkamp, 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 Dale Harold
Osterkamp.
6, No application for appointment of a personal representative is
pending or has been granted in any jurisdiction,
RECEIVED 4/30/2008 at 9:59 AM
RECEIVING # 938579
BOOK: 693 PAGE: 203
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Page 1 of 3
7, As claiming distributees, we are entitled to payment or delivery of
any tangible personal property of Dale Harold Osterkamp" including
deposits held by any bank, savings and loan institution, credit
union, asset management service, or like depository.
000204
DATED THIS 30th day of April, 2008,
STATE OF WYOMING )
) ss,
County of Lincoln )
The undersigned LARRY OSTERKAMP, 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.
~/~
La~sterkamp 0/
Larry Osterkamp, personally known to me did appear before me
and, upon being duly sworn, perse£1,ally did Si92î(t :ozgoing document
and verification thereof this?ìJ day of ',2008.
Witness my hand and official seal.
DENISE SARGENT - NOTARY PUBlIC
COUNTY OF STATE OF
LINCOLN WYOMING
My Conmisslon Expires May 10,2011
My Commission Expires: .~ to I ¡}.,() I)
Page 2 of 3
STATE OF WYOMING )_
) ss.
County of Lincoln )
- The undersigned JEAN EDINGER, being first duly sworn, states that
she has read the foregoing Application and hereby affirms the same as the
truth, to the best of her knowledge and belief. .
000205
Jea~er ~
JEAN EDINGER, personally known to me did appear before me and,
upon being duly sworn, persory~II~_ lIy did sign Pt!J/e:!ling document and
verification thereof this 31 ~ay of I, 2008.
Witness my hand and official seal.
COUNlY OF
LINCOLN
STATE OF
WYOMING
DENISE SARGENT - NOTARY PUBLIC
My Comrrission Expires May 10, 2011
My Commission EXPires:'11rð /0 I Z2 ( /
Page 3 of 3
I
CERTIFICATE OF DEATH
State File Number: 2007011937
Dale Harold Osterkamp
000206
~ I
DECEDENT INFORMATION
Date of Death: .... October 25, 2007
"" City of Death: Salt Lake City
Age: 69
Place of Birth: Onida, South Dakota
Armed Services: Yes
Spouse.'s..Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
/
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
__ Education:
Father's Name:
Facility Type:
17:10
Salt Lake
July 22, 1938
Male
Never Married
U.S. Navy
High School or GED
John Ferdinand Osterkamp
Hospital Inpatient
\
'\
U.S, Military Retired
Diamondville, Wyoming
Alta Elizabeth Gandy
LDS Hóspital
INFORMANT INFORMATION
Name: Larry Osterkamp':: Relationship:
Mailing Address: ---..... P.O. Box 29, Kemmerer"Wyomil'1g 83101 .....
/
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" ai'öther
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DISPOSITION INFORMATION . ,.....
Method of Disposition: Cremation.. .'. . ." ..:, Date of Disposition: October'31;'\Z007
Place of Disposition: Utah"Funei'al Directors Cremation Center, Sputh Jordan, Utah;: .
..
FUNERAL HOME INFORMATION .... i'I,' ",:. "'.'
Funeral Home: Crandall Funeral Home \ /
Address: PO Box 6, 1 05 East Center Street, Kamas,Wta~ 84036 ,.'
Funeral Director: William W Ball .," ..'.
;.,.
..,:.
"'"
MEDICAL CERTIFICATION '.
C~rtifying Physician: J.~mes E Pearl MD, 3241QthAvenue Súite 170, Salt Lake,Gity, Utah
.....,
CAUSE OF DEATH .......,
Metástatic cancer - pathology pending
Tobacco Use: " Unknówn'ifUser
Medical Examiner Contacted: No Autopsy Perfòrmed: Yes'
.'"
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AutopsyAyailâble:ye,s Manner of Deå~h,:Natural
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November 27,2007
AMENDMENT HISTORY
11/20/2007 Decedent Date.Qf Birth from 07/22/1939 to 07/22/1938
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s IS an exact reproduction of the document registered In the State Office of Vital Statistics
Secu~lty features of this official document Inçlude: Intaglio Border V & R Images In top cycloid~
ultra violet fibers and hologram image of the Utah State Seal over the words "State of Utah" Thl'
document displays the date, s.~al and signature of the S(ate Registrar and the County/District Health O~lcer.
~ê~
Barry E. Nangle, State Registrar
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Gar~dWards
DlrectorlHealth Officer
..~C~~~~yl,~I~~!~t ,~ealth Department