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HomeMy WebLinkAbout939727 AFFIDAVIT OF HEIRSHIP OF .-' I ' E::- \.0-" ~I (V1{!--{L' (0- f'-Æ) Deceased STATE OF Co-~ \ t+O;<"'fì' i... } -r.~ SS, COUNTY OF ~ 'Y Q } -f\-rV\L-HL/ CG~1::1 of lawful age, being first dulyswQrn, on oatb deposes and says: - - ,.' -- That affiant was personally a~ well acquainted with the above named dec~dent during the latter's lifetime, having known deceased for .:s-d- \.:'OG007 years, Decedent died at 'TIt\. \.1 í.J County, State of On or about the q day of (VI c;<-.... Y , 20 0 'i\' , being 'b'~ ). i,o p at the time of death. That the following statements and answers to the following questions are based upon the personal knowledge of affiant and are true and years of age, and a resident of correct: 1. Did decedent leave a will? ~ If so, has the will be admitted to probate are pending, and name and address of executor. ; Give name oi County and State In whlc,h ~UCh proceedings (If decedent left a will, please attach a certified copy of same, together with a copy of the order of court admitting It to probate, and letters testamentary.) 2. If decedent left no will, have administration proceedings been started? It/V said administration proceedings are pending and name and address of administrator. If so, give the name of the county and state in which 3. Have ancillary probate ~~oc~edlnqs ,~een had on decedent's estate? If so, when? {l.Jv L 5 ~c--~~ Where? 4. If no administration proceedings have been started, are there any plans to have the estate administrated? ¡t}'D 5. Did decedent leave, any unpaid taxes, Including federal estate or state Inheritance taxes or other debts? filv possible, the amount of such taxes or other debts, to whom owing, and whether they have since been 'paid If so, give as nearly as ---.--. 6. Was decedent suréty on any bond or guarantor of any other person's Indebtedness at time of death? ¡VO principal debtor, amount, etc. If so, give details as to t1¡fo 7. Were there any suits pending or judgments rendered against decedent at time of death? Ç::. amount Involved and parties , If so, state briefly the nature, 8. Marital Status of Decedent at Time of Death (Married, Single, Divorced, Widow, Widower) 9. If decedent was ever married, give the following Information for each marriage: (List names In order of marriage) Name of Spouse Date of Marriage Living/Dead Divorced Date of Death Was there a property settlement? lÁìíhl--¡{.A1 rÝ\A-1l-lv I'fQ 'r-- \ l:LJ- '2...~ TI€~.¿:" )J or Divorce If "Yes"-attach copy. \. IVù 10. if decedent had any children by any spouse, or adopted any children, give the following information: Name of Child Date of Address Living/Dead Date of Death Birth By Which Spouse [? (J ~1i L...:... vCr' ~ CAV lvt__' \15'ö.,f FORM 540 RECEIVED 6/12/2008 at 2:33 PM RECEIVING # 939727 BOOK: 697 PAGE: 7 JEANNE WAGNER ·r I 11\1r.nl 1\1 r.nIINTY r.1 FRK KFMMF"RER-'WY 1r ,~ 11. If a deceased child left descendents, give the following Information: L'OC.008 Name of Child Date of Address living/Dead Date of Death Birth Name of deceased child . Name of deceased child 12. If decedent left no children or descendents of deceased children, then please furnish the following Information: a. Give names of parents of decedent: Name --_... Address living/Dead Date of Death Father Mother b Give names of brothers and sisters of decedent· Name Relation Address Living/Dead Date of Death rY-"o.a.Y , '/ VIJ-/¡I10 C..J /tI c. Give names of children of deceased brother or sister. Name of Child Child of Date of birth Address Living/Dead WrvL~ NL,0Ì\ 13. If decedent left no heirs covered by Item 12 above, then attach a full and complete affidavit of heirship of said decedent In narrative form. 14. Give !ccatlon or description of homestead of decedent, as of date of death 15. As to each tract of land or Interest In land owned by the decedent at the time of his death which concerns tlils company, give the following Information which wll be used primarily for the purpose of determining whether property was separate or community: (If space provided Is Insufficient attach exhlhlt Ivln same Information as to Aach tract. Description Date From Whom? acquired If acquired byPurëhase, were funds used those of decedent only or community property funds with souse? {)fV\ O~I C~k~ Affiant " IS :1::1-1 Ue...rc~uf D· Address ~,.. ;;}-"\ - 0'6 ./'1. ~ "þùL....N~, ~. y~. qO-L.~J ~ Subscribed and sworn to before me this My commission expires day of ,20 Notary Public SUPPORTING AFFIDAVIT STATE OF /{(IL COUNTY OF } SS. -/lð~'¡'" ~ G. ; \þ't" ~. SQÛpfß: of lawful age, being first duly sworn, on oath s~ates: That ~AA.JeIPr'"'lr I ~ ~I was personally and well acquainted with 'L. \ Ii\. f (\.fb (Y\:t It \o.,¿ì during kIlL lifetime; ,rfC Tha.tft'iv..oL-.b: (ø Se~as read the above affidavit by A"vp'ê'T'Tr ("'4(Lc--:" { and that the facts stated therein are true and correct. -rlft!l~tf-!> ç;1P'--< f1..~. 5"-"2, 7-- ..~ f? Affiant Subscribed and sworn to before me this My commission expires day of ,20 Notary Public FORM 540 \;'0\:,,009 CALIFORNIA ,JURAT WITH AFFIANT STATEMENT . ~ee AttaChed Document (Notary to cross out lines 1-6 below) D See Statement Below (Lines 1-5 to be completed only by document signer[s], not Notary) Signature of Document Signer No.1 _... .__ ._... ...... n' ;:> 3 4 6 Signature of Document Signer No.2 (If any) State of California County of J-..O.$ /rtJae¿e:.5 Subscribed and sworn to (or affirmed) before me on this ~tJ 1}i. day of Ml1ý Date Month (1) IrtJAJ6rTe (!.A-s'G Y Name 01 Signer f , 20 0 g , by Year ) ... ... ... ... "'sUÎANÑe ~ÊÌ ... ~ e CommllslOn # 1638971 ¡ ..... Notary PubIIç - California ~ j' Los Angeles County f -... -... -... ~:or:m:...~_~1~~O proved to me on the basis of satisfactory evidence to be the person who appeared before me (.) (,) (and ðll$e Y Name of Sign" (2) -rmmll5 Place Notary Seal Above OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document, RIGHTTHUMBPRINT OF SIGNER #1 RIGHT THUMBPRINT OF SIGNER #2 Top of thumb here Top of thumb here Further Description of Any Attached Document· Il¡::F¡ b!l1ll-r () ¡::. fhf) Æ.sïf¡ ¡J &P litie or Type of Document: #.LIt1AlB:' M ff/f-'-It-IV /) q Su..PflJ¡er~ 'I..:. //-Ph '? r Document Date: /VI ~y óL9 J ~() ¡ Number of Pages: á . Signer(s) Other Than Named Above: . ©2007 National Notary Association" 9350 De Soto Ave., P.O. Box 2402 "Chalsworth. CA 91313-2402" www.NationaINotary.org Item #5910 Reorder. Call Toll-Free 1-800-876-6827 ;·l·'~": COUNTY OF INYO't;~~ .' HEALTH & HUMAN SERVICES P,O. DRAWER "H", INDEPENDENCE, CA 93526 (~OOOj. 0 ..,r~T£r,u: IrI~'i;tiA I. ~''''MeOFr..eCfC£NT-.ml:;rI\,ÕJlol!Uj CERTIFICATE OF DEATH ~."'J;r o;;~ r:~t.=~':Z>!"" ;;~~:l~!f.N<'·:''''\.Y· .c~~¿£L~t.; .'.1"!T{~Oô'.1(TiA.lfIM ~s.",..~,,!~.c:¡ '-(W~Llil::C. !i1"~fI;;:r r·':;'!r.eR " {~¡~ "s.:.f, .~: ~:~:!-~'!¡ :£'iI'¥¡,- 1JÎ~ IN ,,"'·:·1·00';... ,~ ~ ·~I· "i, ª~ }~11 ~·i·~~iti ."".~." $J~~i ~: ~ :":""".' . t~ J~~ I .t,; I i~' I .3 11 l'j~' 'ËI\ .~; ~, .ii. ~ -I: $ j jj§: *í ;:¡¡; ~. j~ I ~: I i1i -ii'.. :~ 11 11\. 1.(i' ~~f; "" ~ ;tS -1$, ì -*i: I' ~; ~l ì ... ~ ~: ~t J ~ ~ ;',,11- .'t.30IfUOW.,....S.-..;"V<#1,"¿t.A!(";F:"'ST,'.."..D1..f:.!,..'~;1'1 ~ ~ 1·,·,;~<·T>;~Ft"''''''C'''.''''"y ,',t~..,."cvem",""'E" VI r- t : ~~\;v '""'4 .._..clt'....C._ T.r ,,, ..A5 ~EC~r.:CIIT.. 5r:"'IICU.nt.otlo,*P",¡l~~ 'I ,,~~~~::~~,,<,g~:""""'~J'~'."'E"""'D 11. i·/~FlmlJ.s._,~~~'.EOP.::r-C!S:' ~LLI.u¡rf"L$f"",S I.ft.;;"~¡:~,.:«: ;".C"TfI'::Fr:-t:A7'-l -,....~:'.~il 0'''' [ii'''' D'NI Widowed 05/09/2008 3-2008~14-000058 1.1.·;tGlE Elaine Antoinette ".,~.~",:",,~~,,~.¡ [~}K) If>. o ¡CEŒ:Nrs fI~(.e: - LIp"J3ry.(,4r.:~f:,')t'_'tlt.'I~.':1! ,.o:1.'~'!(:'1:;""") ¡ White Bo.emaker .~ y¡~1O '::'F 1'1~:¡'of5!:'o ;p IJIIOLS1AY, !-,¡.. ~ "l7I',f~~"""<"',a;..,II. "'n~?,t""ÆI"I'! 1N.;"'.':1.~'.'. ¡ ! ..... '£''',~ :?11:'¡:C1..;,.\1:I',;~ .tÐ. Cf:·:F..!:ElfT'5 Ft&5IDEltCE IStTft .;.r.,¡ n:'t4!~, ~ .'X.lltcrtl Own HOllIe 60 '" ;t~ ¡¡¡,. "~ U Bisbop is. II'''''O~''NT'¡:; 11.J1Æ_ FELATICH.'U1\P Inyo P.O.Box 693. Bisb .'O.l.ASrlMMt"",.,."., CA .93515 111 Hortb Hain St.. Space 28 ~T,crrY 1;. COWlfY ~HO'<1f«:[ Mark V. Harland. Son ,,~. nr;~t ':F Sl.'FIv;,·/1N'3 SPOC.,ot£ fiRST ... is :å JI ~~ ~I i~ ~~ .1'. "'.'DeLE ~1. '''~ueOf-~'''Tt''eA !""Sf .:!J:l.'.t.t."ClE !J.L/I.,>r Stanley :~ HAJ.rEOf'UO'~ft_.F'RST To alski I ~.~ .".;~i.m: )I;,I':¡CttïlE J7.1JoST ",.,"""~ ,.,I'.l'H-I,'>TATF.: Irene ¡, » 0!5f'OS1nOI'1 ~tF. ,",,"-',*,'œyy '40. P'l.ACe' OF "',HoILCt5PÇSIPOU Schroeder' . IL Inyo ISO Pioneer Lane ~ ·JS'.L"UISEr.tlUO£A 05/12/2008 u. TVptCFOI.S~S) Marland Res: 111 No. Main St.. S . '.1, SlGlMiU"E Of EUIo'i..W£R CR/us 4/¡. ""ME Of :'lJtÆfW. ESTAt-u~"T Brune Mortuary 11) 192 f!J', PI.AŒO~ a£A1)I ~i!i ::!öi :I,. .. Northern 1nyo Hosplta1 1CA COlôNrv :?,.r''''JSJ,;OFt(..ITIi rl~~*':Ì'oWI',I.,..... ",,,_,,,,II'-'OI.:r.."'J:l!Qkns hIr*«tt)'~_,..CONOTlrl.tr~.........!tC . .iðr"'-"1fi)c.,~,~'5kq~" ~ytfllnal'.'bJ!IoN>øI'IOIthcM~1Oir9h.~.OOH::rr ~1",iE. IWWDfATè CAt.'5! )At ;'0;:..,""::.':;..... Hu1tipJ.eTraUllat1c InjurieB in~ '!I, Z ;;~~~. Motor Vehicle Accident 5 .~"~~ ¡q D j,,'õO£p¡:YlNG :3 a.U!'E¡IJ....._N ~ ;;.:=,~"'"OWt.tK 1;1 ~ :"~~.n·¡,,fa\t l,.qif o I;¿ O:"~R GlGhtflCNtT Cœ.on~C!:òSfFll6UTIt;IJ t() CE"ni 8(..'"1 ,iOT ,..eSlA.TiI'lG ~"(ThE t.I'~EFrI.:roNG.:AUSE œVEN ~ 101 \,. ~t~f¡L"'Ct"j~f.'t"''tI.JP·.6f' ! [!J'" 0';0 113, il"S ¡;H:~~~~!I F!~!,Ç"'I,ffD n'R~lf~· t;Çt t'fÎ...;k ,II 1l{:1,f ~~ ; OR I~:) t",K'_ "'1 ~.t<;!d ~~ anrI!i...., ,-....,..~~,,» ;.;:¡ r-~.:»Un' it~. ;",rE~r;E'¡,: ~,...~ ;.WS,~t.'hS '¿lI.IE., ',',s"t,ff!j M,;;:¡¡'-.i.éS. ;.: :tI~';~E i ·~~~,,·-i';,''''~U..,'f.::·;)¡,~ !.~N.!·r.:¡;¡,':" , D··" I!J ""'0,,,« L==.. 1'~f!·L..~t~'~!',......-e-.EA I !IT ':::m! ""'r)I'cCYI ! . "'~ ~~ ~~ ,~! ¡fffi o '" ! ,'':GT f'f nu, ~.': Y!i ;;t.~? 'IY ~.:""';,(::£.E CfA:" '»~~ 1:5. iô''3.'.rAT....,:AE ,~IC TITlE DFCERT"J'JER ~;~ ,·~,.-t"G, ::.-"'~. ~';cr:.v.; S:,I.~.\) "":U T!-E CS<."'!tS sr..."W ':fo«o~"1I,1:t('~1IIo( ~'0'Q0 ·:-.}r~,-....'I~"',y<o'. :~:.~:::: ~:::i3:~~:~'~~,::~::Õ~::~: 'D'~ ~::"Ô ;:'!,~.;:,::mO:~·;:;,:;' ;:.J ·4~·~¡:'i);"7·,\';;'.., I ;~;. ........r·." D·" [ij"" 0,-,« ,05/08/2008 ':"2, .,.:.... ~-: .-('",;. ~ ':':! .'~":f' .;;: 'LiiPll' ¡~.~.. r.::~. (~··:r:"..=~r.., ."tf. '.:_':'1'1:~ ~U.'~~': 5 '" ~ " .0 ~ " "' o u 1536 Highway ~ ..1. '. :":',(....':I!' ....; ¡, ,I.....,:..y ·.:J·C, i-r·~:1 ",' ~"""""'.~ ,-c.' .1..,;. Driver of vehicle tbat was struck in side. ..':"" ,.:,~- .;... '.....,"~' --I.."", ..."~ -...,.; ,,_ ',r ".:.J'."""'. _,'c." 'y, ,:'::',', Sun1and Drive and Hwy. 395. . .' o~'ß:"1?;;:;::__£>__ Bishop, CA 93514 .:,7:....·.·: ' " l.\~ ,'..:.., -""',".';'.'::;--.. ':>.._..',. ~ -,,,;.~'." .- - STATE 'A .ìE(¡JSTRAA ¡ I ~Iljl 1111111111 " ~ 11111 11111 1m IIDIII *000017469* i 05/12/2008 Leon B. Brune, Coroner FAX AUIH.. ~;~~;~I.>i íPlJ....;·r 18 I .e ! o .. ---.,..--..;---- CERTIFIED COpy OF VITAL RECORDS STATE OF CAUFORNIA } COUNTY OF INYO 55 DATE ISSUED MAY 1 3 2008 1\ .- ~~1' - ~\v~,~~t~~ J " /.0 ...,! This is a true and exact reproduction of the document officially registered and placed on file in the office of the INYO COUNTY HEALTH AND HUMAN SERVICES. This cop)' not valid "nle" prepared on engraved borderdispln)'ing raised seaJ and signature uf County Health Officer, HEALTH OFFICER