HomeMy WebLinkAbout957069STATE OF WYOMING
ss.
County of Lincoln
I, Martha D. Halverson, being first duly sworn, do hereby state and allege as follows:
(1) I am an adult, competent to testify, and a Co- Trustee of the W. Stanton Halverson, Jr. Living Trust, dated
August 23, 2004 and first amended July 30, 2007 (the "Trust Distributee.
(2) I make the following affirmations based upon my own best investigation, information and beliefs;
(3) The value of the entire probate estate of the Decedent W. Stanton Halverson, Jr., wherever located, less
liens and encumbrances, does not exceed one hundred fifty thousand dollars ($150,000.00);
(4) Decedent W. Stanton Halverson, Jr. died on September 17, 2010, in the State of Wyoming, and the place of
last residence of said decedent was the County of Lincoln, State of Wyoming. See Attached Death
Certificate;
(5) Thirty (30) days have elapsed since the death of the decedent;
(6) No application for appointment of a personal representative is pending or has been granted in any
jurisdiction;
(7)
(9)
W. Stanton Halverson, Jr. died testate, and pursuant to Article Two, Section 2.01 of the Last Will of W.
Stanton Halverson, Jr., all of the property of W. Stanton Halverson, Jr. is to be distributed to the Trust.
There are no other distributees of the decedent having a right to succeed to the property of W. Stanton
Halverson, Jr. under probate proceedings;
(8) Pursuant to W.S. 2- 1- 201(b), the transfer agent for any security shall change the registered ownership on
the books of a corporation from the decedent, W. Stanton Halverson, Jr., to the Trust;
Pursuant to W.S. 2- 1- 201(c), the county clerk of the county in which any vehicle is registered, when
presented with a copy of this Affidavit of Distribution, shall transfer title of the vehicle from the decedent,
W. Stanton Halverson, Jr., to the Trust;
(10) Pursuant to W.S. 2- 1- 201(d), any bank, savings and loan institution, credit union or any other like
depository, when presented with a copy of this Affidavit of Distribution, shall pay any deposit titled in the
name of W. Stanton Halverson, Jr., together with interest and dividends thereon, to the Trust.
FURTHER AFFIANT SAYETH V NAUGHT.
Dated this I_ fi. day of _Q��.'
e_ M 4r 2010.
STATE OF WYOMING
County of Lincoln
ss.
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO W.S. 2 -1 -201
YV
Martha D. Halverson
PO Box 5009
Etna, WY 83118
The foregoing Affidavit of Distribution Pursuant to W.S. 2 -1 -201 was subscribed and sworn to before me
by Martha D. Halverson, on this fr day of Ot C4 er 2010.
Witness my hand and official seal.
M. KEVIN VOYLES NOTARY PUBLIC
COUNTY OF
LINCOLN
STATE OF
WYOMING
MY COMMISSION EXPIRES JULY 16, 2011
My
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State of Wyomin
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RECEIVED 12/8/2010 at 10:15 AM
RECEIVING 957069
BOOK: 758 PAGE: 428
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AC t 1 j' S3
ITAL RECORD
Decedent:
Name: Walter Stanton Halverson
Gender: Male Social Security Number:
Date of Birth: April 14,.1921 Age at the Time of Death:
Date and Place of Death:
Date of Death:
City of Death:
Location.
Additional Decedent Inform
Place of Birth:
Residence:
Marital Status:
Armed Forces:
N of Father
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or, Facility:
Facility:
Cause of Death:
The immediate cause is liste d
a) Congestive heart failure
I Other Significant
Conditions:
Manner of Death: Natural `Death
CE
September 17, 2010
Afton
Star Valley Medical Center 110 Hospital Lane
atioh:
Rapid. City, South Dakota
Etna, Wyoming
Married Martha Shepard
Yes'
Walter Stanton Halvorson
Mary Grace Robinson
Martha Halverson
Oremation
Schwab Mortuary Crematory, Afton, Wyoming,
Schwab Mortuary, Afton, Wyoming
on the first line followed by any underlying causes.
Certifier:
Type: Physician
Name: Allen D. Carter, M.D.
Address: 110 Hospital Lane PO Box 57 Afton, Wyoming, 83110
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenpr Ctober 01, 2010.
DATE ISSUED:
cI
1
This copy is not valid unless prepared on paper with an engtnyed border.
Relationship:
Lincoln
Wife
Gladys K. Breeden
Deputy State Registrar