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AFFIDAVIT OF DISTRIBUTION
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I, TERRIL YN THURMAN, of lawful age and being first duly sworn upon my oath, depose and state as follows:
1. I am a person with knowledge of the facts stated below:
2. STEWART H. THURMAN died a resident of Lincoln County, Wyoming (death certificate attached).
3 . STEWART H. THURMAN owned in his name alone a 1978 Chevrolet utility truck VIN# CCL448Z194131.
5. More than 30 days had passed since STEWART H. THURMAN's death, he does not have an estate in excess
of $150,000.00 anywhere. No one is entitled to be named personal representative.
6. This Affidavit is hers; the only Distributee entitled to take title to the 1978 Chevrolet utility truck VIN#
CCL448Z194131.
7. This Affidavit is to support the direction that title of the aforementioned personal property be issued to
TERRIL YN THURMAN under Wyoming Statutes 1997 1-2-101 et. al.
Further affiant sayeth not.
T)ated: January 10,2008.
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STATE OF IDAHO
SS
COUNTY OF BONNEVILLE )
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On this Ðceemoer ~ ~before me 'J'V\ ìLh~'<.. \ "S L-€:...e-. , personally appeared TERRIL YN
THURlVlAN, kno'wn or Identlfied to me eel prvveg to m~ 911 tJa8 g;¡,th p.f =.), to be
the person whose name is subscribed to the within instrument, and acknowledged to me that she executed the
same.
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Notary Public J --
My Commission Expires: ~
RECEIVED 5/6/2008 at 4:26 PM
RECEIVING # 938801
BOOK: 693 PAGE: 880
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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STATE OF IDAHO
ØOQB76
000881.
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
DATE F1lED BY STATE REGISTRAR:
Slale of Idaho
CERTIFICATE OF DEATH
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STATE FILE NO.
Otil:_~I~~~::"~U:~.;E:!!~~~:;(~~:O~~r:A~::;'~~':'~':~;'~~'~~:~E·"1i Local Reg. No.
3. SOCIAL seCURITY NUMBER
"" 1. DECEOENrs LEGAL NAME (Include AKA'. II any) (Flrll. Middle, Last Suffix)
I" SEX
I Male
6. BIRTHPLACE (City and Slale. Terrllory, or Foreign Country)
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TYPI! OR
PAINT'"
PIAMANI!HT
BLACK INK
DO NOT US!
FELT T1P PEN
~ 69
~ 7.. RESID
~ Idaho
:,s d. E ANDNU BE
~ 1485 Juni er Driver
œ 8. MARITAL S ATUS AT TIME OF DEATH
~ Gi Married 0 Married, but ,operated 0 WIdowed
:E 10. ¡~~E~ ,S.
ff; FORCES7 Stewart McCombs Thurman
]! oa Yel 121. MOTHER:S MAIDEN NAME (First, Middle, last, SuNlit)
~ 0 No Adell Hum
ð 138. INFORMANrs NAME (Type or prinl)
Ž ' Terri Lyn Thurman
« '" 14. METHOD F DISP 8m N
Õ r;a: Burial 0 Cremallon
t= 0 Donation 0 Enlombment
D:: 5a. Removallrom Idaho
000''''''(
:¡¡ * 170,5
1938
Afton, ':!y_oming_._______._
7c. CITY OR TOWN
FOA
INSTAUC110NI
...
HAND&OOtcl
L ~~ BIR.£~eA~E {Slalø. Terrll~-:-õrF-ôi8iö;' -Counlryl -.-
W omin
12b. BIRTHPLACE (5Iale, Terrilo~, or ForeÎg-ñCoun',y¡---
13b. RELATIONSHIP TO DECEDENT
.1
22. COUNTY OF DEATH
Bonneville
26. TIME PRONOUNCED DEAD
("hI) Augus t 19, 2007 0830
27. CAUSË OF OEATH'" ---'-----.--.
PART I. Enler Ihe ~ - -dIseases. Injurl8s, or compllcaltons - -Ihal dlrecny caus8d Ihe dealh. DO NOT enler lermlnel events such as cardiac
BITesl, respiratory arrasl, or ventrlculer fibrillation wnhoul showing Ihe eliology. DO NOT ABBREVIATE. Enler only one cause on a line: .
IMMEDIATE CAUSE (F11"I81 r::::..... r....o~"
disaBle or condIllon .... a. . ,Lg: \
re,ulllng In dealh) DUE TO lor... eonnquel'lC'l or);
. . _..__.(~.~~~
Approximale 'nlerval:
Ons8110 Dealh
/.'" 1/IÚV
Sequenllany Ilsl condlllons,
II any, leading 10 Ihe cause
Ilstad on line 8, Enler Ihe
..c. UNDERLYING CAUSE
ñi LAST (dlReese or In \Jry
~ Ihel Inlllaled Ihe e\l9nls
Õ reRulllng In dealh)
I!? PART II. Enler
::>
o
J:
N
...
c
:ë
,,.
~
b.
DUE TO for... conllqtJ1 nc:tI 01):
~:;.
OUE TO (or It. !;On,equenc.o' :
d.
but 1'101 resulting in Ihe underlying cause given In Part I "28a. ~:;F~~:~PiY': 28b. ~;~~~AB~EO;~6~1:~~ri:
. : THE CAUSE OF DEA11i1
eYes ~No OYe, [1 No
.-..--.---
C.l Nol pregnant bul pragnanl43 days 31. MANNER OF DEATH
to 1 year befofe deelh ~alural 0 HomIcide
:J Unknown 11 pregnan' wI,hin Ihe pasl [J Accidenl 0 Pending In\l9111g8110n
year rJ Suicide lJ Could -not be del8rmlned
34. PLACE OF It-IJURY (Decedenl's home. farm, slreel. conSlruclion sU., 35. INJURY AT WORK?
nuraing home, reslauranl. lorest. elc.)
29. DID SACCO USE
CONTRIBUTE TO DEATH?
30, IF FEMALE (Aged 10-54):
o Nol pregnanl within pasl year
o Pregnanl alllme of dealh
o Nol pregnanl. bul pregnenl
'HUhln 42 days 01 dealh
33, TIME OF INJURY
DYes
J Probably
r.~1 Yes
1J No
(24hr)
u_n____.__n.___
.-...--.-. ....--.------...
Gilyrrown or County
ZIp Code
Slreel and Number Of .Localion Apartmenl Number
37, DeSCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY, STATE THE TYPE(S) OF VEHICLE(S) INVOLVED (Automobile, pickup. mOlorcycle. ATV, bicycle, elc.1
SPECIFY WHICH VEHICLE DECEDENT OCCUPiED, II applicable '
TRANSPORTATION ; 38ã.WAšDECËõËNT: U DriýëàÕperalorO Passenr.j'ê-;-: 38-":WHÃTSÄF'ËtŸ·ÕËViëE(S) m[f DECEDENT usElËÑ!P(ÔŸ1---
INJURY ONLY I 0 Pedeslrian 0 Olher (Specify) , n Seal 8ell 0 Child safely seal IJ Helmel 0 Air bag I.:¡ None 0 Unknown
3ge. CERllAER (Check only 01'18, baRed on official capacity lor this cermicale) 39b. LICENSE NUMBER
5õ PHYSICIAN 0 PHYSICIAN ASSISTANT !l ADVANCED PRACTICE PROFESSIONAL NURSE
- To Ihe best of my knowledge. deelh occurred 811he lime, dale, and place. and due 10 lhe t1tiJll1IJ cause(s)/manner slaled
o CORONER
- On 11'18 basis 01 ekamlnatlon and/or Invesl glT1Ðn, In my op~lon. dealh occurred allhe lime. dale. and place. and duø ro Ihe cause(s)
and manner slaled. ~ . IÎ
Slgnarunt end Tille of Certlner ~ ".~. l .
.." 39d. NAME, ADDRESS. AND ZIP CODE t£S9 Fiê.Fi (Type or prinl)-·-""----- .----- ·_···_n______.__ ---- ----.-..
Iff DIA11-I WAS
DUE TO OTHER
THAN NA-ruRAL
CAUS!!!S,
nil CORONER
M!lII
COMPLE1l! AND
SION THE
CERTIFICATE
/CI-t~'):::'(V
39c. DATE SIGNED
C:Ji./~~
MM DD yyyy
Christian T. Shull M.D.' 2330 OeSoto St.' Idaho Falls Idaho
Oa. RBI N ES ARY: he coroner', s gnalure In Ihls lIem supersedes Ihal 01 Ihe physlclen.
physlcfan ...18Ienl, or edvenced pracllca proleulonal nurse. and Ihe coronlllr becomes Ihe cer1ifier 01 record.
83404
40b. DÃfËŠioNED
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This Is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS.
DATE ISSUED, LL<~,w¡,¡ 77-< zar¡
This copy not valid unless pr pared on engraved border
displaying state seal and signature of the Registrar.
~t-;>d~
'. JANE S, SMITH
STATE REGISTRAR
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