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Home My WebLink About958000STATE OF WYOMING COUNTY OF LINCOLN AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2 201 ss. 1 000+21' I, Curtis W. Haderlie, being first duly sworn, on oath depose and state that I am making this affidavit pursuant to W.S. 2 -1 -201, on behalf of myself as sole distributee, as hereinafter set forth, and that I make the following statements in connection therewith: 1. That Edith Haderlie aka Edith Weber Haderlie became deceased on August 29, 2008, in Idaho Falls, Bonneville County, State of Idaho; that said decedent was a resident of Thayne, Lincoln County, Wyoming, at the time of her death; that said decedent was married at the time of her death; that said decedent died intestate; that at the time of her death said decedent was married to LaMar Haderlie and owned the brand described below with him as "husband and wife therefore, that upon her death, all of decedent's interest in the property described below became the property of her surviving spouse, LaMar Haderlie. 2. That LaMar Haderlie aka LaMar Fredrick Haderlie became deceased on May 1, 2010, in Afton, Lincoln County, State of Wyoming; that said decedent was a resident of Thayne, Lincoln County, Wyoming, at the time of his death; that said decedent was single at the time of his death; that said decedent died intestate; that I am the son of the decedent; and that I am the sole and only party entitled to the estate of the decedent in accordance with the laws of the State of Wyoming. 3. That the value of the entire estate of said decedent, wherever located, does not exceed $150,000.00. 4. That more than thirty (30) days have elapsed since the date of death of the decedent. 5. That no application for the appointment of a personal representative of said decedent is pending or has been granted in any jurisdiction. RECEIVED 2/9/2011 at 10:28 AM RECEIVING 958000 BOOK: 762 PAGE: 214 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 000215 6. That the following named distributee is the sole and 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 Curtis W. Haderlie Son 7. That among the assets owned by said decedent was the following: Wyoming Livestock Brand Record I.D.: A0872100 -7 Issue Date: 5/29/1975 Attached is a copy of the Brand Record The image of the brand is as follows: The above property should be transferred to the undersigned. 8. That attached hereto and incorporated herein by this reference is a certified copy of the death certificate for the decedent. 9. 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 2nd day of February, 2011. 2 6W,„4 Curtis W. Haderlie Subscribed and sworn to before me by Curtis W. Haderlie, this 2nd day of February, 2011. Witness my hand and official seal. 4' GERALD L. GOULD1 NOTARY PUBLIC I County of Lincoln State of Wyoming �wsti My Commission Expires May 2, 2011 My commission expires: May 2, 2011. 3 NOTARY PUBLIC 000216 JAN -20 -2011 06:02PM FROM- +3078837072 T -920 P.002/004 F -476 000217 S 'd OOEL GSVOS N3O1S3AI1 AM AdZE;t OIOZ'7 'NVP ITAL RECORD DECEDENT LEGAL NAME. EDITH WEBER HADERLIE NAME ADDRESS OF FUNERAL FACILITY NALDER'S FUNERAL HOME, SHE'LLEY, IDAHO DESCRIPTION OF HOW INJURY OCCURRED DEPARTMENT OF HEALTH AND WELFARE BUREAU OF VITAL RECORDS AND HEALTH STATISTICS CERTIFICATE OF DIAT�T Date Filed SEPT 08 20 SIX SOCIAL SECURITY NUMBER AGE DATE OF BIRTH FEMALE 81 YEARS JUNE 25 1927 BIRTHPLACE PLACE OF RESIDENCE FREEDOM, IDAHO THAYNE, WYOMING MARI TAL STATES AT TI ME OF DEATH NAME OF SUR fMNG SPOUSE (If We, maiden name) WAS DECEDENT EVER IN U.S. ARMED FORCES? MARRIED LAMAR FREDRICK HADERLIE NO FATHER •NAME BIRTHPLACE WALTER WEBER SWITZERLAND MOTHER MAIDEN NAME BIRTHPLACE. SYLVIA CLARK UTAH METHOD OF DISPOSITION FUNERAL SERVICE LICENSEE REMOVAL FROM STATE JASON PHILLIP MECHAM DATE OF DEATH TIME OF DEATH OR LOCATION OF DEATH I j COUNTY OF DEATH AUG. 29, 2008 11:07 A.M. IDAHO FALLS, IDAHO BONNEVILLE CAUSE OF DEATH (underlying cause Iasi) Approximate Interval Between Onset and Death e AN'pXIC ENCEPHALOPATHY 48, HOURS DUE Td (or as a consequence of): b MU`LTISYSTEM ORGAN FAILURE 4 HOURS! p DUE TO (or as a consequence o c CONGESTIVE ME ART FAILURE 5 YEARS DUE TO (or as a consequence'of)„ d t;HRONICA7RTAL EIB 5 YEARS OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH bLt not resulting In the underlying cause given above WAS AN AUTOPSY PERFORMED? NONE STATED NO MANNER OF DEATH NAME OF CERTIFIER TITLE NATURAL PATRICK D. GORMAN, M.D. PHYSICIAN CORONER SUBSEQUENT CERTIFICATION IF NECESSARY V Il II II 411 tl1i DATE OF INJURY TIME OF INJURY PLACE OFiwur y INJURY AT LOCATION WHERE INJURY OCCURRED This is a true and,;I ori`e'bt reproduction of the document officially registered and placed on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS. SEPTEMBER 12, 2008 DATE ISSUED: This copy is not. valid' unless prepared on engraved border displaying state seal and signature of the Registrar. JANE S: SMITH STATE REGISTRAR '�7 /�r OULU UM OICAM Hap Date and Place of De Date of Death: City of Death: Decedent: Name: Gender: Date of Birth: Location: Additional Decedent Place of Birth: Residence: Marital Status: Armed Forces: Name of Father: Name of Mother: Informant: Disposition: rIethod'of Disposition: 'Place of Disposition: Funeral Home or Facility Facility: Schwab Mortuary, Afton, Wyoming Cause: of Death: The immediate cause is listed ,on the first line followed by any underlying causes. (a) Renal Failure (b) Chronic Obstructive Pulmonary Disease (c) Obstructive Uropathy (d) Peripheral Vasculaf,Disease Other Significant Conditions: Manner of Death: Certifier: Type: Name: Address: Date Filed: LaMar Fredrick Haderlie Male November 25, 1922 ath: May 01, 2010 County of Death: Afton Star Valley Medical Center 110 Hospital Lane Information: Thayne, Wyoming {Thayne, Wyoming Widowed No Clifford Moroni Haderlie Myrtle Coy Gena Roberson Relationship: Thayne Cemetery, Thayne, Wyoming, Natural Death Time of Death' Physician Christian M. Morgan, M.D. 110 Hospital Lane, PP Box 579, Afton Wyoming ,83110 June 03,`2010 This is a true certification of the document on file in the office of Vital Statistics Services, Cheyenne, Wyoming,. 0 G DATE ISSUED: Friday, June 04,2010- This copy is not valid unless.preparcd on. papgrnvith an,engravedbordat.. DEPARTMENT OF HEALTH CERTIFICATE OF DEATH State File Number: Social Security Number::', Age at the Time of Death: 2010- 001560 87 years Lincoln Gladys K. Breeden Deputy State Registrar 00{10219 Daughter Interval: Days Years Months. Years L3 CERTIFICATION OF VITAL RECORD T(� efm.