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HomeMy WebLinkAbout959484STATE OF WYOMING COUNTY OF LINCOLN AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2 -1 -201 ss. Name Relationship Sandra S. Lewis Spouse 0©0430 I, Sandra S. Lewis, 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 Sherald D. Lewis aka Sherald Dean Lewis became deceased on April 24, 2010, in Tulsa, Oklahoma; that said decedent was a resident of Auburn, Lincoln County, Wyoming, at the time of his death; that said decedent was married at the time of his death to the undersigned; that said decedent died testate; that I am the surviving spouse and heir 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. 2. That the value of the entire estate of said decedent, wherever located, does not exceed $150,000.00. 3. That more than thirty (30) days have elapsed since the date of death of the decedent. 4. That no application for the appointment of a personal representative of said decedent is pending or has been granted in any jurisdiction. 5. That the following named distributee is the sole and only party entitled to the estate of the decedent; that there are no other distributees of the decedent having a right to succeed to any of the property of the decedent under probate proceedings; and that therefore the following named claiming distributee is entitled to payment or delivery of all of decedent's property: RECEIVED 5/31/2011 at 12:42 PM RECEIVING 959484 BOOK: 767 PAGE: 430 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 6. That among the assets owned by said decedent was the following: State of Wyoming Brand No. A1570100 That attached hereto and incorporated herein by this reference is a copy of the Owners Wyoming Brand Certificate. All right, title, and interest in and to the above property should be transferred to the undersigned. 7. That attached hereto and incorporated herein by this reference is a certified copy of the death certificate for the decedent. 8. That the original of this affidavit is being filed of record in the office of the County Clerk of Lincoln County, Wyoming, in compliance with W.S. 2- 1- 201(c), as amended. EXECUTED as of the 27th day of May, 2011. Subscribed and sworn to before me by Sandra S. Lewis, this 27th day of May, 2011. Witness my hand and official seal. GERALD L. GOULDING NOTARY PUBLIC County of State of Lincoln Wyoming My Commission Expires May 2, 2015 My commission expires: May 2, 2015. 2 NOTARY PUBLIC %Yazxobi.41. Sandra S. Lewis 000431 OWN!RS°WYOMING BRAND CERTIFICATE SHERALD D. LEWIS 3221 HWY 238 AUBURN, WY 83111 RHC,RSS,RHH DATE 6/20/1966$ Void: March 1, You should car Y... rat s+ Issued by WYOMIN0 L Cheyenne, Wyomi Void without Dept. Seal NUMBER A1570100 in: January 1,2017 -:wth you at all times. 'I OCK BOARD X12. a Executive Officer 000432 Decedent: State File Number; 2010 -001 192 Name: Sherald Dean Lewis Gender: Male Social Security Number: Date of Birth: January 12, 1930 Age at the Time of Death: 80 years Date and Place of Death: Date of Death: April 24, 2010 County of Death: Lincoln City of Death: Auburn Location; 3221 Hwy 238 Additional Decedent Information: Place of Birth: Marion, Utah Residence:': Auburn,: Wyoming Marital Status: Married Sandra Stacey Armed orces: Yes Name of Father Gilbert B Lewis Name of Mother: Pearl White Informant: Sandra Lewis Relationship: Wife Disposition. I Method of Disposition: Burial Place of Disposition: Auburn Cemetery, Auburn, Wyoming Funeral Home brFacility: Facility: Schwab Mortuary Afton, Wyoming Cause of Death: The immediate cause is listed on the first line followed by any under causes Interval: (a) prostate cancer 1/ 4r. Other Significant Conditions:: Manner of Death: Natural Death` STATE OF WYOMING DEPARTMENT OF HEALTH :CERTIFICATE OF DEATH Certifier: Type: Physician Name: Allen D. Carter, M.D. Address: 110 Hospital Lane, PO Box 579, Afton, Wyoming, 83110 Date filed April 29,,;2010 Gladys K. Breeden Deputy State Registrar 00043 46027 This is a true certification of the document on file In the office of Vital Statistics Services Che I ii "April 30, 2010 DATE ISSUED: 7 This copy is not.yalid unless prepared on paper with an engljaved,border ii I I I1. 1 I.I.I.LI.I ,I.I.I.I.f:I,I.LLLIJJJJ.CI l t 5.$, "7 If rr 101, ster rook t CERTIFICATION OF VITAL RECORD 42,W