HomeMy WebLinkAbout965438IN THE DISTRICT COURT OF THE THIRD JUDICIAL DISTRICT
IN AND FOR THE COUNTY OF UINTA, STATE OF WYOMING
IN THE MATTER OF DETERMINATION OF HEIRSHIP OF
REBECCA ELLEN BORINO, a/k/a BECKY BORINO,
Deceased.
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
AFFIDAVIT FOR DISTRIBUTION OF ESTATE
We, Karen Ann Farr, Janelle Marie Hill, Holly Kaye Lowen, Becky Jean (Johnson) Pace,
Tonia Lee Cassels, Kristy LynnFarr, Tony Victor Farr, Maxie Dean Borino, and Paula Kay Spheeirs,
being first duly sworn, on oath depose and state as follows:
1. That we are over the age of twenty -one (21) years.
2. That Rebecca Ellen Borino, also known as Becky Borino is our mother and grandmother.
3. That our mother and grandmother, Rebecca Ellen Borino, also known as Becky Borino died
on the 16t day of January, 2012 in the City of Tucson, County of Pima, State of Arizona as
is shown by the certified copy of the certificate of death that is identified as Exhibit 1 and
attached hereto and made part of this instrument by this reference.
4. That our mother and grandmother, Rebecca Ellen Borino, also known as Becky Borino had
a Will upon her death and that she left the remainder of her estate to the following
individuals which shall be distributed as follows: Twenty (20 percent to my daughter,
Karen Ann Farr and the remainder of my estate shall be distributed to my grandchildren,
share and share alike, per capita who are alive at the time of my death, who are: Janelle
Marie Hill, Holly Kaye Lowen, Becky Jean (Johnson) Pace, Tonia Lee Cassels, Kristy Lynn
Farr, Tony Victor Farr, Maxie Dean Borino, and Paula Kay Spheeirs.
5. The only known assets of the Estate of Rebecca Ellen Borino, also known as Becky Borino
are the following:
a. DWS Investments
Account #533802528
Owners: Tony Borino Rebecca E. Borino
b. Pioneer Investments
Account #00078829201
Owners: Tony Borino Rebecca E. Borino
Probate \Borino\Affidavit of Distribution
00099
Probate No.
RECEIVED 7/6/2012 at 2:13 PM
RECEIVING 965438
BOOK: 789 PAGE: 99
JEANNE WAGNER
LINCOLN COUNTY CLERK, ERER, WY
distributed as follows:
6. We are the only ones entitled to payment or delivery of those assets and they shall be
a. Twenty (20 percent to Karen Ann Farr;
b. Ten (10 percent to Janelle Marie Hill;
c. Ten (10 percent to Holly Kaye Lowen;
d. Ten (10 percent to Becky Jean (Johnson) Pace;
e. Ten (10 percent to Tonia Lee Cassell;
f. Ten (10 percent to Kristy Lynn Farr;
g. Ten (10 percent to Tony Victor Farr;
h. Ten (10 percent to Maxie Dean Borino; and
i. Ten (10 percent to Paula Kay Spheeirs.
7. If any other asset(s) of Rebecca Ellen Borino, also known as Becky Borino is discovered, it
should be distributed as described above.
8. That the value of the entire estate of Rebecca Ellen Borino, also known as Becky Borino,
wherever located, does not exceed two hundred thousand dollars ($200,000.00).
9. That thirty (30) days have elapsed since the date of the death of Rebecca Ellen Borino, also
known as Becky Borino.
10. That no application for appointment of a personal representative is pending or has been
granted in any jurisdiction regarding Rebecca Ellen Borino, also known as Becky Borino.
Dated this _4L day of Joile_. 2012.
STATE OF ARIZONA
COUNTY OF P1ta_ >ss.
N ANN FARR
uuiOO
I, Karen Ann Farr, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
This Affidavit for Distribution of Estate was signed and sworn to before me this,0
day
of Q flt 2012 by Karen Ann Farr.
Probate \Borino \Affidavit of Distribution
Page 2 of 10
NOTAR P d
My Commission Expires:. 7 1
Sr
Dated thi day of (4). e 2012.
STATE OF WYOMING
COUNTY OF (y }rn r if)
ss.
00101
I, Janelle Marie Hill, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
sr
This Affidavit for Distribution of Estate was signed and sworn to before me this Q1 day
of \Lt 2012 by Janelle Marie Hill.
Probate \Borino \Affidavit of Distribution
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Page 3 of 10
NOTARY PUBLIC
My Commission Expire'§;. mac=- L 1 vi s
Dated this J day of AisiU_ 2012.
STATE OF ALASKA
COUNTY OF 1- l u d U I s I ss.
Probate \Borino \Affidavit of Distribution
4
1 4 i :e SA
I* i NOTARY
i PUBLIC
OF AtP
.H,,I UN
I, Holly Kaye Lowen, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
This Affidavit for Distribution of Estate was signed and sworn to before me this 1 day
of JL.LYLS1 2012 by Holly Kaye Lowen.
Page 4 of 10
[The remainder of this page is intentionally blank.]
NOTARY PUBLIC n
My Commission Expires:
00102
Dated this dn day of J uNE 2012.
STATE OF t\OruI4 C UN
ss.
COUNTY OF 1 NC m
LEANN ALDRIDGE
NOTARY PUBLIC
BUNCOMBE COUNTY
NORTH CAROLINA
MY COMMISSION EXPIRES MAY 5, 2016
Probate \Borino\Affidavit of Distribution
Page 5 of 10
I, Becky Jean (Johnson) Pace, being first duly sworn, states that I am one of the affiants
noted above in the Affidavit for Distribution of Estate, that I have read the same, know the contents
thereof, and that the statements contained therein are true.
TARY PUBLIC I
My Commission Expires: `j J Q0 1
[The remainder of this page is intentionally blank.]
00103
This Affidavit for Distribution of Estate was signed and sworn to before me this c 0 day
of jt A N i 2012 by Becky Jean (Johnson) Pace.
STATE OF ARIZONA
COUNTY OF Pa:v/2A_,
Dated this 0.23 day of
Laiza Martinez
Notary public Arizona
Pima County
My Commission Expires
June 26, 2015
Probate Botino\Affidavit of Distribution
ss.
Page 6 of 10
2012.
ge4.614._
TONIA LEE CASSELS
I, Tonia Lee Cassels, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
TONIA LEE CASSELS
00104
his Affidavit for Distribution of Estate was signed and sworn to before me this o2 day
of 2012 by Tonia Lee Cassels.
NOTARY PUBLIC
My Commission Expires: czol 9/S
[The remainder of this page is intentionally blank.]
STATE OF COLORADO
COUNTY OF
Probate \Borino \Affidavit of Distribution
Dated this /9 day of U 2012.
n 1 j ss
I, Kristy Lynn Farr, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
T is Affidavit for Distribution of Estate was signed and sworn to before me this
of v A.-r— 2012 by Kristy Lynn Farr.
[The remainder of this page is intentionally blank.]
Page7of 10
NOTARY PUBLIC
My Commission Expires: t3
00105
day
Dated this day of s J Ufl!_- 2012.
STATE OF ARIZONA
COUNTY OF rnk
ss.
TO VICTOR FARR
oo10
I, Tony Victor Farr, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
TO VICTOR FARR
This Affidavit for Distribution of Estate was signed and sworn to before me this day
of 0 2012 by Tony Victor Farr.
Probate \Borino\Affidavit of Distribution
1 PENNE R. BISHOP
I Notary Public Arizona
i PNna County
4 ti c ,f My Comm. Expires Jun 17, 2015
NOTARY LIC
Mao mizsinn Expires:
[The remainder of this page is intentionally blank.]
Page 8 of 10
6-17-15-
Dated this (-W day of J 2012.
STATE OF WYOMING
COUNTY OF L oL ;Ytm.o�_.
Probate\Borino \Affidavit of Distribution
ss.
Page 9 of 10
M IE DEAN BORINO
I, Maxie Dean Borino, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
This Affidavit for Distribution of Estate was signed and sworn to before me this alStda
of Cti 2012 by Maxie Dean Borino.
•O' ARY P IC
mmission Expires: 1 aol
[The remainder of this page is intentionally blank.]
00107
Dated this 2— day of 2012.
Probate \Borino \Affidavit of Distribution
PAULA KAY SPHEERI
00108
STATE OF COLORADO
ss.
COUNTY OF -e o-J
I, Paula Kay Spheeris, being first duly sworn, states that I am one of the affiants noted
above in the Affidavit for Distribution of Estate, that I have read the:sane, know the contents
thereof, and that the statements contained t rei are true.
AULA KAY SPH ,IRIS
Page 10 of 10
[The remainder of this page is intentionally blank.]
This Affidavit for Distribution of Estate was signed and sworn to before me this day
of 01 \J 2012 by Paula Kay Spheeris.
NOTARY P F: LIC
My Commission Expires: -r 6y 17 ;b IV
Date Issued: 01 -20 -2012
This is a true certification of the facts on file with the OFFICE OF VITAL RECORDS,
ARIZONA DEPARTMENT OF HEALTH SERVICES, PHOENIX, ARIZONA.
Revised 04/2010
PATRICIA ADAMS
ASSISTANT STATE REGISTRAR
This copy not valid unless prepared on a form displaying the State Seal and impressed with the raised seal of the issuing agency.
STATE OF ARIZONA
DEPARTMENT OF HEALTH SERVICES OFFICE OF VITAL RECORDS
CERTIFICATE OF DEATH State File tun :i n9..9n19_nn117Q
ANY ALTFRATION OR ERASURE VOIDS THIS DOCUMENT
N eft. i n/, .P ri wt si At. ,y.
nep rimen( of
1 L e,aii Service
CERTIFICATION OF VITAL RECORD
1. DECEDENT'S LEGAL NAME (FIRST, MIDDLE, LAST) 2. AKA'S (IF ANY) 3. DATE OF DEATII'
REBECCA ELLEN BORING JANUARY 16, 2012
4. SEX 5. SOCIAL SECURITY NUMBER: 6. DATE OF BIRTH 7. AGE UNDER 1 YEAR UNDER 1 DAY
S. MONTHS 9. DAYS 10, HOURS r1 1. MINUTES
FEMALE 05 -19 -1917 94
12. PLACE OF DEATH HOSPITAL: 13. PLACE OF DEATH OTHER THAN HOSPITAL'
INPATIENT E,RJOLITPATIENT DEAD ON ARRIVAL NURSINGHOE OR LONGTERM
CARE FACILITY M
11 RESIDENCE III HOSPICE FACILITY m mart RESIDENCE
14. FACILITY NAME (OR STREET ADDRESS IF NOT A FACILITY): 15, CITY, TOWN &ZIP CODE OR LOCATION OF DEATH: 16. COUNTY OF DEATH:
8950 SOUTH WILTBANK ROAD (TUCSON 85737 PIMA
17. BIRTHPLACE (CITY AND STATE OR FOREIGN COUNTRY) 16. MARITAL STATUS AT TIME OF 19. NAME OF SURVIVING SPOUSE (MAIDEN NA IF WIFE,)'
DEATH:
BURR OAK, INDIANA WIDOWED
2c(. DECEDENT'S USUAL RESIDENCE STREET ADDRESS: 121. CITY AND COUNTY: 22. STATE 23. ZIP CODE 24. EVER IN'THE ARMED I
FORCES
S
34 CHICAGO ST, IDIAPAONDVILLE, LINCOLN WYOMING 83116 NO
25. WAS DECEDENT OF HISPANIC ORIGIN? 26, DECEDENT RAGE(5): 27. IF AMERICAN INDIAN OR ALASKA NATIVE.
I� NO, NOT SPANISH, HISPANIC OR LATINO WHITE 0 OTHER ASIAN (SPEC FY) SPECIFY UP TO a TRlaF9
0
O YES, MEXICAN, MEXICAN AMERICAN, CHICANO
0 BLACK, AFRICAN AMERICAN PRIMARY ORENRIi
QEp TRIBE:
13 NATIVE HAWAIIAN
0 YES, PUERTO RICAN 0 ASIAN INDIAN
O YES, CUBAN 0 CHINESE OTHER PACIFIC ISLANDER (SPECIFY) AO0ITIQNAL TRIBE
0 YES, OTHER (SPECIFY) O FILIPINO
O JAPANESE 0 OTHER (SPECIFY)
13 GUAMANIAN OR CHAMORRO ADDITIONAL TRIBE
0 UNKNOWN 0 KOREAN
26. OCCUPATION: 0 VIETNAMESE
0 SAMOAN 0 ITKI
UNKNOWN ADONALTR1BEr
HOMEMAKER 0 AMERICAN INDIAN OR ALASKA NATIVE
29. FATHER'S NAME (FIRST, MIDDLE, LAST) 30. MOTHER'S NAME (FIRST, MIDDLE, LAST NAME PRIOR TO FIRST MARRIAGE)
CHARLES L. HATTEN EFFIE DRUSILLA EMIGH
31. INFORMANT'S NAME 32.RELATIONSHIP 33, INFORMANT'S MAILING ADDRESS
KAREN FARR DAUGHTER 11200 S SIERRITA MOUNTAIN RD PMB 315, TUCSON,` ARIZONA 85736
34. NAME AND ADDRESS OF FUNERAL FACILITY: 35. FUNERAL DIRECTOR: 36. LICENSE
NUMBER:
BRING'S MEMORIAL CHAPEL 236 S. SCOTT AVE TUCSON, AZ FRANK J PETERSON FUNERAL DIRECTOR F1204
37. METHOD(S) OF DISPOSITION: 38. NAME AND LOCATION OF 1st DISPOSITION FACILITY: 39. NAME AND LOCATION OF 2nd DISPOSITION FACILITY:
REMOVAUBURIAL SOUTH LINCOLN` CEMETERY, KEMMERER, WYOMING, NONE
r ar IIIEDICAL CERf AT:ION SEC 1OH..i".Di,USEOF q ,EATH PART F Y alltl N 1 1 1 G
OF
IMMEDIATE CAUSE 40, A 41. APPROXIMATE INTERVAL.
ATHEROSCLEROTIC CARDIOVASCULAR DISEASE UNKNOWN
DUE TO OR AS A 42. B 43. APPROXIMATE INTERVAL:
CONSEQUENCE OF.
DUE TO OR AS A 44. C 45. APPROXIMATE INTERVAL:
CONSEQUENCE OF:
DUE TO OR AS A 46.0
CONSEQUENCE 01-: 47. APPROXIMATE INTERVAL
CAUSE OF DEATH P HT 11 ro a, jt� �Y)T?l r'
B
48. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING 49. INJURY? 50. INJURY AT WORK? 51. MANNER OF DEATH 52, TIME'OF DEATH I
IN THE UNDERLYING CAUSES GIVEN ABOVE: n
NO NO NATURAL DEATH 2103
53. WAS AN AUTOPSY PERFORMED? 54. WERE AUTOPSY FINDINGS AVAILABLE TO
CONPLETETNE•CAUSEOF DEATH?
HYPERTENSIVE CARDIOVASCULAR DISEASE NO
CAUSE AND MANNER OF DEATff i
o Certifying PhysrcianlNurse Practitioner/Physician's Assistant To the best of my 55. NAME OF PERSON COMPLETING CAUSE OF DEATH: 56. DATE CERTIFIED:
cc
knowledge, death occurred due to the cause(s) and manner stated.
Medical Examiner/Tribal Law Enforcement Authority On the basis of examination,
and /or investigation, to my opinion, death occurred at the time, data, and place, and
due to the cause(s) and manner stated_ CYNTHIA M PORTERFIELD, D.O. 01 -17 -2012
57. CERTIFIERS ADDRESS: 58. NAME OF IEGISTRAR: 59.DATE REGISTERED
2825 E DISTRICT STREET TUCSON, AZ 85714 AUDREY ROGERS 01 -18 -2012