HomeMy WebLinkAbout948996AFFIDAVIT OF DISTRIBUTEE FOR
TRANSFER OF WYOMING CERTIFICATE OF TITLE
I, Lisa Alice Taylor Ashment, being first duly sworn and upon her oath, state the
following:
1. That the decedent, Tyrel Richard Ashment, died on the 22nd day of
November, 2oo8, as evidenced by this certified copy of the death certificate attached as
Exhibit A.
2. That the decedent, Tyrel Richard Ashment was not married at the time of
his death and does have surviving children.
3. That the name of the distributees entitled to payment or delivery of
decedent's property is Lynn Noah Ashment and Lisa Alice Taylor Ashment, who are the
natural parents of the decedent.
4. That the value of the entire estate of the decedent, wherever located, less
liens and encumbrances, does not exceed one hundred fifty-thousand ($150,000.00)
dollars.
5. That more than thirty (3o) days have elapsed since the date of the
decedent's death.
6. That no application for appointment of a personal representative is
pending or has been granted in any jurisdiction.
7. That the above-named distributees are entitled to payment or delivery
of the decedent's property listed below and there are not other distributees of the
decedent having a right to succeed to the property under probate proceedings.
8. That the undersigned request that the following described property be
transferred to Lynn Noah Ashment and Lisa Alice Taylor Ashment, who are the natural
parents of the decedent, and that title to said motor vehicle be transferred into said
name.
9. Property description:
Year Make/Style Color Vehicle Identification Number
1996 GMC 2GTEK19R3T1543536
Bowers Law Firm
Transfer of WYCertificate ofTitle RECEIVED 8/19/2009 at 9:36 AM
Lisa Ashment
RECEIVING #
Page I of 2 948996
BOOK: 730 PAGE: 172
JEANNE WAGNER
I IN( nl N ('(-)1 INTY (-A FRK VPhAnAGRGa knrv
DATED this f day of ~U01 , 2009.
17~)t k J~vk
Lila Alice Taylor Ashment, Distributee
State of
)SS.
County of
Before me on the /&day of 64Z;t1 2009, personally appeared
LISA ALICE TAYLOR ASHMENT, being first duly sworn by me upon their oath says
that the facts alleged in the foregoing instrument are true.
WITNESS my hand and official seal.
C,' )
Notary Public
My commission expires:
ERIKA BENCHNOTARY PUBLIC
County of l~ State of
Lincoln i Wyoming
My Commission, expires July 31, 2012
Bowers Law Firm
Transfer of IVY Certificate of Title
Lisa Ashment
Page 2 of 2
STATE OF V)VYOM I
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.fs s j DEPARTMENT OF HEALTH r7 01F
STATE OF WYOMING
AFFIDAVIT TO AMEND "PENDING" DEATH CERTIFICATE
STATE' CERTIFICATE NUMBER: 2008-003693 C
Please complete legibly using BLACK print or type only
First Name. Middle Name - ' Last Name
Tyrel Richard Ashment
EtaceofDeathgCounty "
DateofDesth -of Dmtb: City
November 22, 2008 Freedom L'nrriln
Per VitAI StlaHsties Services Rules and Regulations Chapter 5 fi tion,~(ej This affidavit %ill serve as the supplemental 'report
And is to be comnged by the Coroner Deptify Coroner `pr Physician who signed the certificate CiI+TLY.
J
Item
Number
Information as stated on the original Death Certificate.
Information as it should read after completion of investigation.
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SIGNATURE OF REVIEWQIG OFFICIAL.
NOTARY PUBLIC
SUBSCRWED AND SWORN TO ME ON.THIS DATE.;.
IN THE COUNTY OF
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MY COMMISSION EXPBtES
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