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Home My WebLink About959732RECEIVED 6/20/2011 at 10:33 AM RECEIVING 959732 BOOK: 768 PAGE: 239 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON 000239 WE, NAOMI G. JOHNSON, TORY T. JOHNSON, LORI L. SMITH, FARRELL KIPP JOHNSON, CHRISTINA LAVIVIAN STOKER, NATASHA LYNN HESS, SIERRA LEE JOHNSON, AND BILL RAHR BREWER being the heirs at law of the Estate of Farrell Johnson, first being duly sworn, upon oath, depose and say: 1. That we are all of the heirs at law of the Estate of Farrell Johnson, and we have knowledge of and are competent to testify concerning the facts as stated below. 2. That Farrell Johnson died on February 14, 2009. Attached hereto is a copy of his official Certificate of Death, certified to by Vital Records Services, Department of Health, State of Wyoming, the public authority with which the original Certificate of Death is of record according to law. 3. That Farrell Johnson was the sole owner of the following vehicles at the time of his death: a. 1958 Laycock 2 -Horse Trailer VIN: 58 -T -8; b. 1959 Ford Pickup VIN: F10C9R 23 617; and c. 1980 Homemade Flatbed Trailer VIN: S23821W. AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 1 OF 10 000240 4. That the value of the entire Estate of Farrell Johnson that is subject to probate, less liens and encumbrances, does not exceed One Hundred Fifty Thousand Dollars ($150,000.00). 5. That thirty days (30) days have elapsed since the death of Farrell Johnson. 6. That no application for appointment of a Personal Representative for the Estate of Farrell Johnson is pending or has been granted in any jurisdiction. 7. That upon the death of Farrell Johnson, we, as the heirs at law, became the owners of the property described herein under the intestate laws of the State of Wyoming. 8. That we hereby request that the County Clerk of Lincoln County, when presented with a certified copy of this Affidavit, re -title the above described vehicle to the name of Naomi G. Johnson, as follows: Naomi G. Johnson P.O. Box NBU 5 -9 Auburn, Wyoming 83111. DATED this'` day of .1y1 th 2011. AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 2 OF 10 STATE OF WYOMING SS. COUNTY OF LINCOLN I, NAOMI G. JOHNSON, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. day of SUBS ED AND SWORN TO before me by NAOMI G. JOHNSON this G90 WITNESS my hand and official seal. Stale ,lung 4, 2.01 My Commission expires: (o -�'f NAOMI G. JOHN Yud 4 N M y NAOMI G. J j NSON AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 3 OF 10 000241 STATE OF WYOMING SS. COUNTY OF LINCOLN I, TORY T. JOHNSON, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. SUBSCRIBED AND SWORN TO before me by TORY T. JOHNSON this 74 ay WITNESS my hand and official seal. My Commission expires: 7 TORY _J0)-11,evc/in JOHNSON I TORY T JOHNSON AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 4 OF 10 000242 STATE OF WYOMING SS. COUNTY OF LINCOLN 2010. WITNESS my hand and official seal. My Commission expires: t1, 20� cD L RI L. SMITH AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 5 OF 10 I, LORI L. SMITH, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. yr SUBSCRIBED AND SWORN TO before me by LORI L. SMITH this 5t day of NOTARY P PAMELA J. CLEMENT NOTARY PUBLIC County of "�y State of Lincoln ?�r, Wyoming My Commission Expires U 03 lot o 000243 STATE OF WYOMING SS. COUNTY OF LINCOLN I, FARRELL KIPP JOHNSON, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. day of WITNESS my hand and official seal. My Commission expires: 2010. J am, FARRELL KI OHNS N SUBSCR ED AND SWORN TO before me by FARRELL KIPP JOHNSON this AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 6 OF 10 LISA HOKANSON NOTARY PUBLIC County of Lincoln State of Wyoming My Commission Expires August 16, 2013 000244 STATE OF WYOMING SS. COUNTY OF LINCOLN WITNESS my hand and official seal. My Commission expires: /1--)-0 `'L 3 Cskda NOT CHRISTINA LAVIAN STOKER I, CHRISTINA LAVIVIAN STOKER, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. CHRISTINA LAVIVIAN STOKER SUBSCRIBED AND SWORN TO before me by CHRISTINA LAVIVIAN STOKER this av day of 1 2010. af JASMINE NEWELL COUNTY OF LINCOLN MY COMMISSIONEXpMR NOTARY PUBLIC STATE OF WYOMING NOVEMBER 20, 2013 PUBLIC AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 7 OF 10 000245 STATE OF WYOMING SS. COUNTY OF LINCOLN I, NATASHA LYNN HESS, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. day of SUBSCRIBED AND SWORN TO before me by NATASHA LYNN HESS this WITNESS my hand and official seal. My Commission expire 2010. NATASHA LYNN HESS 000246 6p- NOTAR PUBLIC LEE R, bENNI NQTARY PUB County of Lincoln State of Wyoming My Commission Expires Aug. 25, 2012 AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 8 OF 10 STATE OF SS. COUNTY OF I, SIERRA LEE JOHNSON, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. day of k 2010. WITNESS my hand and official seal. My Commission expires: 6( vi l AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 9 OF 10 000247 SUBSCRIBED AND SWORN TO before me by SIERRA LEE JOHNSON this i' DAVID MAURICE INSON Notary Public State N UMh COMM. No. 312820 My Comm. Expires Joo 19.2014 STATE OF WYOMING SS. COUNTY OF LINCOLN WITNESS my hand and official seal. I, BILL RAHR BREWER, first duly having been sworn on oath, depose and say: that I am one of the Affiants in the foregoing Affidavit, that I have read the foregoing Affidavit, that I know the contents thereof, and that I believe the contents to be true and correct. 000248 BILL R BREWER SUBSCRIBED AND SWORN TO before me by BILL RAHR BREWER this 30 day of 2010. (d. NOTA '4 PUBLIC My Commission expires: I 2 _a 01 AFFIDAVIT FOR DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF FARRELL JOHNSON PAGE 10 OF 10 JASMINE NEWELL NOTARY PUBLIC COUNTY OF 1 STATE OF LINCOLN :1 {9, WYOMING MY COMMISSION EXPIRES NOVEMBER 20, 2013 DECEDENT LEGAL NAME FARRELL D. JOHNSON OF IDAHO DEPARTMENT OF HEALTH AND WELFARE BUREAU OF VITAL RECORDS AND HEALTH STATISTICS CERTIFICATE OF DEATH 2 0'0 9 State File No. Da;�'e Filet F E B R UARY 2 SIX SOCIAL SECURITY NUMBER AGE. OATSOFBIRTH MALE 73 YEARS DECEMBER 1 -6, 193'5 BIRTHPLACE PLACE OF RESIDENCE AUBURN, WYOMING AUBURN, WYOMING I MARIYAL STATUsh11 4E OF'iOEATHI NAME' oF'SURJNING SPOUSE' maiden name) WAS DECEDENT EVER IN U.S. ARMED FORCES? I MARRiSuED; NAOMI GAYS TAYLOR YES FATHER f�1AME BIRTHPLACE ROLL IN JOHNSON WYOMING MOTHER MAIDEN NAME BIRTHPLACE LAVON DAVIS IDO METHOD OF DISPOSITION FUNERAL SERVICE LICENSEE REMOVAL FROM STATE MICHAEL D. BELL NAME AND ADDRESS OF FUNERAL FACILITY SCHWAB�MORTUARY, AFTON, WYOMING DATE OF DEATH TIME OF DEATH CITY TOWN OR LOCATION OF DEATH COUNTY OF DEATH FEB. 14, 2009 4:05 P.M. BOISE, IDAHO ADA CAUSE OF DEATH (underlying cause last) Approximate Interval Between Onset and Death CHRONIC DEMYELINATING ,I NFLAMMATORY,POLYNEUROPATHY DUE TO (or as a consequence of): n SEVERE :HYPDXEMIA DUE TO (onus a consequence ol): DUE (or as kconseggance of) OTHER SIGNIFICANT CONDITIONS' CONTRIBUTING TO DEATH but not resulgng in the 'underlying cause given above WAS AN AUTOPSY PERFORMED? NONE STATED NO MANNER OF DEATH NAME OF: CERTIFIER TITLE NATURAL ST�,VEN D FULLER, D.O. PHYSICIAN CORONER SUBSEQUENT CERTIFICATION IF NECESSARY IODATE OF INJURY, TIME OF It PLACE OF INJURY INJURY AT WORK'? LOCATION WHERE INJURY OCCURRED DESCRIPTION OF HOW INJUFN: OCCURRED 11. 14 :r. This is a true and ;correct reproduction of the document' officially registered and placed �Qf'� 8�' ��hlr on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS. LF, FEBRUARY 24, 2009 F H r—•••■11, i bAT,E ISSUED: FLLLLrrM�L�1 fi r PIP wi0 ZE Oy_ This is hot.valid unless prepared on engraved border dlspIaying state seal and signature of the Registrar. JANE S. SMITH STATE REGISTRAR 2009 -01261 CERTIFICATION OF VITAL RECORD t ali