HomeMy WebLinkAbout965328STATE OF WYOMING
SS.
COUNTY OF LINCOLN
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF DONALD H. WOODEN
COME NOW PATSY M. WOODEN, BART H. WOODEN, VALERIE L. JORGENSEN,
RANELL C. SHUMWAY, and PATRICIA M. CAZIER, after being sworn and under oath, hereby
stating (pursuant to Wyoming Statutes 2 -1 -201, which authorizes Affidavits of Distribution) as follows:
1. That Donald H. Wooden, a resident of Alpine, Wyoming, died on February 18, 2012. An
official copy of the Certificate of Death of Donald H. Wooden is attached hereto.
2. That Donald H. Wooden died intestate.
has been granted in any jurisdiction.
00553
RECEIVED 6/29/2012 at 11:07 AM
RECEIVING 965328
BOOK: 788 PAGE: 553
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
3. That, in accordance with the requirement of Wyoming Statutes 2- 1- 201(a), we hereby
state:
a. That the value of the entire estate of Donald H. Wooden, wherever located, less
liens and encumbrances, does not exceed Two Hundred Thousand Dollars ($200,000.00).
b. That Thirty (30) days have elapsed since the death of Donald H. Wooden.
c. That no application for appointment of a Personal Representative is pending or
d. That we are the heirs at law of Donald H. Wooden. As the heirs at law of Donald
H. Wooden, we are the persons entitled to the assets of the Estate of Donald H. Wooden. There
are no other persons or entities having a right to said assets under probate proceedings.
4. That as the heirs at law of Donald H. Wooden, we hereby request that the following asset
belonging to Donald H. Wooden be transferred to "Patsy M. Wooden and Bart H. Wooden, as Joint
Tenants with Rights of Survivorship 2000 Ford Pickup, VIN No. 1FTNW21S8YED55674. The
original Certificate of Title for that asset is enclosed with this Affidavit.
DATED this 131 day of June, 2012.
WITNESS my hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of
Lincoln
State of
Wyoming
My Commission Expires: July 16, 2015
My Commission expires: 07//6//
PAT M. PAT M. WOODEN
0554
ON THIS, the 1 day of June, 2012, Patsy M. Wooden, affiant herein, appeared before me,
and being duly sworn under oath, affirmed that the facts stated in this Affidavit of Distribution are, to the
best of her knowledge, information, and belief, true and complete.
DATED this 1 36 day of June, 2012.
ON THIS, the 13 day of June, 2012, Bart H. Wooden, affiant herein, appeared before me, and
being duly sworn under oath, affirmed that the facts stated in this Affidavit of Distribution are, to the best
of his knowledge, information, and belief, true and complete.
WITNESS m
hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of State of
Lincoln Wyoming
My Commission Expires: July 16, 2015
My Commission expires: 0/
DATED this 1 day of June, 2012.
ON THIS, the Z ?41 day of June, 2012, Valerie L. Jorgensen, affiant herein, appeared before me,
and being duly sworn under oath, affirmed that the facts stated in this Affidavit of Distribution are, to the
best of her knowledge, information, and belief, true and complete.
WITNESS my hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of i State of
Lincoln i�,''� Wyoming
My Commission Expires: July 16, 2015
My Commission expires: 07
BART H. WOODEN
VALERIE L. JORGNSEN
00555
DATED this IVA day of June, 2012.
ON THIS, the 1 day of June, 2012, RaNell C. Shumway, affiant herein, appeared before me,
and being duly sworn under oath, affirmed that the facts stated in this Affidavit of Distribution are, to the
best of her knowledge, information, and belief, true and complete.
WITNESS m
hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of j,i:,'� State of
Lincoln '.'fl -,y' Wyoming
My Commission Expires: July 16, 2015
My Commission expires: 0'7
My Commission expires: 0
DATED this 1 day of June, 2012.
ON THIS, the 1 3411 day of June, 2012, Patricia M. Cazier, affiant herein, appeared before me,
and being duly sworn under oath, affirmed that the facts stated in this Affidavit of Distribution are, to the
best of her knowledge, information, and belief, true and complete.
WITNESS my hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of e State of
Lincoln ;N� Wyoming
My Commission Expires: July 16, 2015
6
/NOTA Y PUB
ATRICIA M. CAZIE
NOTA PUBLI
005.'56
;:CERTIFICATION OF VITAL RECORDS
Date Filed
mu nw yr
SIX SOCIAL SECURITY NUMBER AGE DATE OF BIRTH
MALE 71 YEARS NOVEMBER 02, 1940
BIRTHPIACE PLACE OF RESIDENCE
ROCK SPRINGS, WYOMING ALPINE, WYOMING
MARITAL STATUS AT TIME OF DEATH NAME OF SURVIVING SPOUSE (l, ail!, maiden name) I WA U.S S ARMED DECEDENT EVER IN
RCES.
MARRIED PAT TITENSOR YES
FATHER NAME
BIRTHPLACE
HENRY EARL WOODEN MISSOURI
MOTHER MAIDEN NAME
BIRTHPLACE
CLARA LAVONNA GROUTAGE WYOMING
wo i wN FUNERAL SERVICE LICENSEE.
REMOVAL FROM STATE JASON P. MECHAM`
NAME AND ADDRESS OF FUNERAL FACIUTY
NALDER'S FUNERAL HOME, SHELLEY, IDAHO
DATE OF DEATH I TIME OF DEATH I rvN TMA.ni no i nnevrno ne n
.,n WUNIY 01- DEATH
FEB. 18, 2012 I 2:42 A.M. IDAHO FALLS, IDAHO BONNEVILLE
CAUSE OF DEATH (underlying cause last) •A'pproxset and imate Interval Between
OnDeath
CHRONIC OBSTRUCTIVE PULMONARY DISEASE 10. YEARS
DUE TO (or as a consequence of):
b INTERSTITIAL PULMONARY FIBROSIS 4 YEARS
DUE TO (or as a consequence of):
HEART DISEASE 8 MONTHS
DUE TO (or as a consequence of):
'END STAGE RENAL FAILURE 8 MONTHS
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting )mlhe untler)ying cause given above W AN AUTOPSY
FORMED?
NONE STATED NO
MANNER OF DEATH NAME OF CERTIFIER TITLE
NATURAL PATRICK D. GORMAN, M.D. PHYSICIAN
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
tea=
Win..
GATE OF INJURY
TIME OF INJURY PLACE OF INJURY IN1UR? AT
WORM
LOCATION WHERE INJURY OCCURRED
DESCRIPTION OF HOW INJURY OCCURRED
FEBRUARY 22, 2012
STATE..:OF IDAHO
IDAHO DEPARTMENT OF H EAL T H AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
CERTIFICATE OF DEATH
This is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF VITAL RECORDS AND: HEALTH.STAT)STICS.
State File No 2012
00557
FEBRUARY 22, 2012
DATE ISSUED:
This copy not valid unless prepared on engraved border
i+7 displaying state seal and signature of the Registrar.
0 1,1 7 1 g. PENCE (WOO 4
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ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE',?
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