HomeMy WebLinkAbout963842STATE OF WYOMING
COUNTY OF LINCOLN
Item
AFFIDAVIT OF DISTRIBUTION
OF DECEDENT'S PERSONAL PROPERTY
PURSUANT TO W.S. 2 -1 -201
RECEIVED 3/29/2012 at 10:09 AM
RECEIVING 963842
BOOK: 783 PAGE: 750
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ss.
I, GINA GITTENS, 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 distributee, as hereinafter set
forth, that I make the following statements in connection therewith:
1. That LESLIE ROBERT WILKINSON became deceased on January 17, 2012 in
Afton, Lincoln County, State of Wyoming, and was a resident in Lincoln County, State of
Wyoming, at the time of his death; that said decedent left GINA GITTENS, as daughter,
SHAWN WILKINSON, as son, KARI PERRY, as daughter, and Robert Wilkinson, as son; that
the sole and only persons entitled to the items of property of the estate of said decedent at the
time of his death are the distributees hereinafter named; a copy of the Certificate of Death of
decedent is attached hereto as Exhibit "A
2. That the value of the entire estate of said decedent, wherever located, does not
exceed $200,000.00.
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 distributees are the sole and only parties 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 the decedent's
property:
Name and Address Relationship
Gina Gittens
P.O. Box 132
Fairview, WY 83119
Shawn Wilkinson
100 Sunset Ave., #17
Evanston, WY 82930
Kari Perry
6618 State Hwy. 238
Afton, WY 83110
Robert Wilkinson
938 Flint Rd.
Coldwater, MI 49036
1994 GMC pickup
VIN 1 GTEK 19K2RE547149
Daughter
Son
Daughter
Son
6. That among the asset owned by said decedent is the following:
Location Approx. Value Distributee
Afton, WY 1,500.00 Gina
Affidavit of Distribution
Page 1 of 2
0 "0 "750
1995 GMC pickup Afton, WY 2,000.00 Shawn
VIN 1GTHK34F2SZ543989
TOTAL 3,500.00
Bank accounts, and estimated value
Type of Account Est. Value How to Distribute
Checking account 2,500.00 1/4 to each child
TOTAL ESTIMATED VALUE 6,000.00
7. That an executed copy of this Affidavit is being presented to the transfer agent for
the above listed asset in compliance with W.S. 2 -1 -201.
Under penalty of perjury, I declare that I have read the foregoing and the facts alleged are
true, to the best of my knowledge and belief.
EXECUTED this QS day of mi f: k
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
CRYSTAL. L. J AUGHT R NOTARY PUBS
County c:,,i I
Wyoming
I Y omin
9
My Cornmiss x pires r'onruary 3
My Commission Expires: 2 _3
State of
NOTARIAL OFFICER
Affidavit of Distribution
Page 2 of 2
2012.
..GINA GITT S, Petitioner
P.O. Box 132
Fairview, WY 83119
Daughter
SUBSCRIBED AND SWORN to before me, a Notarial Officer, by GINA GITTENS this
2$' day of AU rat 2012.
(4 Zit
0 °071
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent Information:;
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition: 'I
Place of Disposition:
Funeral Home or Facility:,'
Facility:
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) Myocardial Infarction
(b) Arteriosclerotic Cardiovascular Disease
Other Significant Chronic Obstructive Pulmonary Disease, Diabetes
Conditions:
Manner of Death: Natural Death
Certifier:
Type:
Name:
Address:
Date Filed:
600014`
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUEDTuesday, February 07,'2012
Anted[ 9nR Ic.RU /c I;tyuapauy
Leslie Robert Wilkinson
Male
January 11, 1943
January 17, 2012
Afton
49 E.: 6th Ave,
Onaway, Michigan
Afton, Wyoming
Divorced
Yes
Leslie Roberts Wilkinson Sr.
Donna Mae Comfort
Gina Gittens
Cremation
Schwab Mortuary Crematory, Afton, Wyoming
Schwab Mortuary, Afton, Wyoming
Coroner
Michael Richins, Coroner
274 N St, Box 57, Grover, Wyoming, 83122
February 03, 2012
This copy is not valid unless prepared on paper with an engraved border.
State File Number:
Social Security Number:
Age at the Time of Death:
Relationship:
372 -44- 3023
69 years
Daughter
18:00 (Approximate)
Thomas 0. Forslund
Director and State Registrar
Fr 35'�� 5 ,{S
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CERTIFICATION OF VITAL RECORD..
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