HomeMy WebLinkAbout956012STATE OF WYOMING
COUNTY OF Lincoln
In the Matter of the Estate of
Rayma Anglesey
1.
Decedent.
I, Derek L. Anglesey
behalf of myself and all other distributees, that:
My mailing address:
PO Box 972
Street Address
Cody, WY
City, State
82414
Zip Code
My residence address is:
120 Robertson Street
Street Address
Cody, WY
City, State
82414
Zip Code
2. The decedent's full name is:
Rayma Anglesey
No.
AFFIDAVIT OF SMALL ESTATE
DISTRIBUTEES
S.S.
2
0
IN THE DISTRICT COURT
JUDICIAL DISTRICT
upon duly sworn, state on my oath, on
RECEIVED 10/15/2010 at 9:49 AM
RECEIVING 956012
BOOK: 755 PAGE: 398
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
3. More than thirty (30) days have elapsed since decedent's death The date of the
decedent's death was December 31 2009 I have attached a
copy of the death certificate hereto.
4. I am a distributee of the decedent estate as defined in Wyoming Statutes 2- 1- 301(XIII).
All distributees of the decedent, including myself, are listed as follows:
Surviving Spouse:
Relationship: Son
Name Derek L. Anglesey
Address: PO Box 972
City: Cody
State: WY
Zip Code: 82414
DOB: (minors only)
Relationship:
Name
Address:
City:
State:
Zip Code:
DOB: (minors only)
Relationship:
Name
Address:
City:
State:
Zip Code:
DOB: (minors only)
Relationship:
Name
Address:
City:
State:
Zip Code:
DOB: (minors only)
Relationship:
Name
Address:
Address:
City:
State:
Zip code:
none
3
000399
City:
State:
Zip Code:
DOB (minors only)
Relationship:
Name
Address:
City:
State:
Zip Code:
DOB: (minors only)
Relationship:
Name
Address:
City:
State:
Zip Code:
DOB: (minors only)
5. That the value of the entire estate of the decedent, wherever located, less liens and
encumbrances, does not exceed One Hundred Fifty Thousand Dollars ($150,000.00).
000400
6. No application or petition for the appointment of a personal representative is pending or
has been granted in any jurisdiction.
7. The claiming distributees are entitled to payment or delivery of the property, and there
are no other distributees of the decedent having a right to succeed to the property under probate
proceedings.
Under penalties of perjury, I/We declare that 1/We have read the foregoing and the facts alleged
are true, to the best of my /our knowledge and belief.
Date: /oV/ 070/0 Signature of Petitioner:
4
Print Name of Petitioner: Derek L. Anglesey
120 Robertson Street
Street Address
Cody, WY
City, State
82414
Zip Code
307 272 -5331
(Area Code) Telephone No.
Son
Relationship to Decedent
STATE OF WYOMING
COUNTY OF Lincoln
The foregoing instrument was acknowledged before me this
i
(date) by e r L
(Seal)
My Commission Expires:
NOTAR P B W YOMING
Lincoln County
M Commission Ex Tres Jan. 21 2013
OII2 �3
Acknowledgement
5
Printed
000401
Niflcj
ame
STATE OF WYOMING
CERTIFICATE OF DEATH
Gladys K. Breeden
Deputy State Registrar
Decedent:
Name:
Gender:
Date of Birth:
Other Significant
Conditions:.
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
441744
CERTIFICATION OF VITAL RECORD:
Rayma Rickenbach Anglesey
Female Social Security Number
June 21, 1947 Age at the Time of Death: 62 years
Afton, Wyoming
Natural Death
Date and Place of Death:
Date of Death: December 31, 2009
City of Death: Smoot
Location: 493 Lincoln County Rd. 148
Additional Decedent Information:
Place of Birth:
Residence: Smoot, Wyoming
Marital Status: Widowed
Armed Forces: No
Name of Father: Joseph Albert Rickenbach
Name of Mother: Siota Letia Parsons
Informant: Misty Jo Stadler
Disposition:
Method of Disposition: Burial
Place of Disposition: Smoot Cemetery, Smoot, Wyoming
Funeral Home or Facility:,
Facility:
,Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes:,
(a) Metastatic Carcinoma Abdomen
Schwab Mortuary, Afton, Wyoming
Orson D. Perkes, M.D>
110 Hospital Lane, Afton, Wyoming, 83110
January 22 2010
This is a true certification of the document on file in the office of Vital
Records Services, Cheyenne; Wyoming.
Monday, January 25, 2010
DATE ISSUED:`
p
;This copy.is not valid unless. on,.paper an engrnved.bordGt:
1R ,,,1, 11111 III,I,I�I.I 1J 11J I.Il .l l.t:l .I.I.IJ.L(J.I.I.I.IJ tJJJJJLW.IJ.
State File Number:
Lincoln
County of Death:
Relationship:
Y 4, E 3'• �,'�s� �1` rf /t,
2009- 003972
Daughter