HomeMy WebLinkAbout947272AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF
DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2-1-201
STATE OF WYOMING
COUNTY OF LINCOLN
ss.
00U37 8
I, Annette Luthi, being first duly sworn, on oath depose and state that I am making this
affidavit pursuant to W.S. 2-1-201, in behalf of myself as the heir at law and distributee, as
hereinafter set forth, and that I make the following statements in connection therewith:
1. That Henry Cordell Luthi became deceased on October 29, 2008, at 332 Freedom
North Road, Freedom, WY 83120, and was a resident of 4001 Stateline Road,
Freedom, WY 83120, at the time of his death; that said decedent died testate; that I am
the surviving spouse of the decedent; that the individual listed in Paragraph 5 below is
the only party entitled to the estate of the decedent in accordance with the laws of the
State of Wyoming.
2. That the value of the entire estate of said decedent, wherever located, does not exceed
$150,000.00.
3. That more than thirty (30) days have elapsed since the date of death of the decedent.
4. That no application for the appointment of a personal representative of said decedent is
pending or has been granted in any jurisdiction.
5. The following named distributee is the only party entitled to the estate of the decedent;
that there are no other distributees of the decedent having a right to succeed to any of
the property of the decedent under probate proceedings; and that therefore the following
named claiming distributee is entitled to payment or delivery of all of decedent's
property:
Name Relationship
Annette Luthi Spouse
RECEIVED 5/20/2009 at 11:44 AM
RECEIVING # 947272
BOOK: 723 PAGE: 378
1 JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0®0319
6. That there were policies of insurance on which the decedent, Henry Cordell Luthi, was
the insured, the proceeds of which should now be paid to the above-named beneficiary,
namely:
a. Beneficial Policy No. BL0925765.
b. Beneficial Policy No. BL0208507
The proceeds of the policies of insurance listed above should now be paid to
the beneficiary herein named, Annette Luthi.
7
That attached hereto and incorporated herein by this reference is a certified copy of the
death certificate for the decedent.
8
That the original of this affidavit is being filed of record in the office of the County Clerk
of Lincoln County, Wyoming, in compliance with W.S. 2-1-201(c), as amended.
EXECUTED as of this 19th day of May, 2009.
' f
Annette Luthi
Subscribed and sworn to before me by Annette Luthi, this 19th day of May, 2009.
Witness my hand and official seal.
EGERALDL.d
U~QTARY PUBLICState of
Wyoming
,IM
r,!, , P,a;iren May 2, 2011
My commission expires: May 2, 2011.
r
NOTARY PUBLIC
.
39233
This is a true
certification
on file in the office of Vital
.
Cheyenne,. Wyoming,_
Records Services,
DATE ISSUED: November 07, 2008
(G
rL
^
This copy is not valid unless prepared on paper with an engraved border
i
Gladys K. Breeden
Deputy State Registrar
i