HomeMy WebLinkAbout965691Name of Spouse
Date of Marriage
Living /Dead
Divorced
Date of Death
or Divorce
Was there a property settlement?
If "Yes attach copy.
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AFFIDAV OF HEIRSHT OF
C,/ r-e-f'.614/ 164
Deceased
STATE OF
COUNTY OF
oath
0/1/2.0U (5 n 1 V/feJ% of lawful age, being first duly sworn, on oath deposes and says:
That affiant was personally and well acquainted with the above named decedent during the latter's lifetime, having known deceased
years.
Decedent died at .0a/ ,l/i 2
on or about the
it day of s 4":" 19 ,f being years age, resident of
/�L�.e41"l at the time of death.
1 111111 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 Hill 111111011111
LORETTA
1 of
0 CLERK o SWEETWATER C WY Page PG2 P101377
T the following statements and answers to the following questions are based upon the personal knowledge of affiant and are
true and correct:
1. Did decedent leave a will If so, has the will been admitted to probate Give name of County and State in which
such proceedings are pending, and name and address of executor.
(If decedent left a will, please attach a certified copy of same, together with a copy of the order of court admitting it to probate, and letters
testamentary.)
2. If decedent Left no will, have administration proceedings been started') If so, give the name of the county and state in which
said administration proceedings are pending and name and address of administrator
3. Have ancillary probate proceedings been had on decedent's estate?
If so, when? Where?
4. If no administration proceedings have been started, are there any plans to have the estate administered')
5. Did decedent leave any unpaid taxes, including federal estate or state inheritance taxes or other debts? 6 4-- Z 1) If so, give as nearly as
possible, the amount of such taxes or other debts, to whom owing, and whether they have since been paid
6. Was decedent surety on any bond or guarantor of any other person's indebtedness at time of death? C� If so, give details as to
principal debtor, amount, etc
7. Were there any suits pending or judgments rendered against decedent at time of death? If so, state briefly the nature, amount
involved and partiec
8. Marital Status of Decedent at Time of Death (married, single, divorced, widow, widower) -"r CJ C� �l r.Ge
9. If decedent was ever marred, give the following information for each marriage: (List names in order of marriage)
10. If decedent had any children by any spouse, or adopted any children give the following information:
RECEIVED 7/23/2012 at 2:2
RECEIVING 965691
BOOK: 79P PAGE: 39
JEr,.,..L_ NAGNER
•a.. ,c24
00039
County, State of 74-- ears e and a resi t
Name of Child
Date of
Birth
Address
Living /Dead
Date of Death
By Which Spouse
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If
Qz)...k J 3 70 G (.1)
AFFIDAV OF HEIRSHT OF
C,/ r-e-f'.614/ 164
Deceased
STATE OF
COUNTY OF
oath
0/1/2.0U (5 n 1 V/feJ% of lawful age, being first duly sworn, on oath deposes and says:
That affiant was personally and well acquainted with the above named decedent during the latter's lifetime, having known deceased
years.
Decedent died at .0a/ ,l/i 2
on or about the
it day of s 4":" 19 ,f being years age, resident of
/�L�.e41"l at the time of death.
1 111111 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 11111 Hill 111111011111
LORETTA
1 of
0 CLERK o SWEETWATER C WY Page PG2 P101377
T the following statements and answers to the following questions are based upon the personal knowledge of affiant and are
true and correct:
1. Did decedent leave a will If so, has the will been admitted to probate Give name of County and State in which
such proceedings are pending, and name and address of executor.
(If decedent left a will, please attach a certified copy of same, together with a copy of the order of court admitting it to probate, and letters
testamentary.)
2. If decedent Left no will, have administration proceedings been started') If so, give the name of the county and state in which
said administration proceedings are pending and name and address of administrator
3. Have ancillary probate proceedings been had on decedent's estate?
If so, when? Where?
4. If no administration proceedings have been started, are there any plans to have the estate administered')
5. Did decedent leave any unpaid taxes, including federal estate or state inheritance taxes or other debts? 6 4-- Z 1) If so, give as nearly as
possible, the amount of such taxes or other debts, to whom owing, and whether they have since been paid
6. Was decedent surety on any bond or guarantor of any other person's indebtedness at time of death? C� If so, give details as to
principal debtor, amount, etc
7. Were there any suits pending or judgments rendered against decedent at time of death? If so, state briefly the nature, amount
involved and partiec
8. Marital Status of Decedent at Time of Death (married, single, divorced, widow, widower) -"r CJ C� �l r.Ge
9. If decedent was ever marred, give the following information for each marriage: (List names in order of marriage)
10. If decedent had any children by any spouse, or adopted any children give the following information:
RECEIVED 7/23/2012 at 2:2
RECEIVING 965691
BOOK: 79P PAGE: 39
JEr,.,..L_ NAGNER
•a.. ,c24
00039
County, State of 74-- ears e and a resi t
Description
Name of Child
Date of
Birth
Address
Living /Dead
Date of Death
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Mother
in
L Sl
Name of deceased child
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ar d s d
Eli -01NMAINIMIN
IILLIN
POMO
a a
_�a
Name of deceased child
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Description
Name
Address
Living /Dead
Date of Death
Father
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Mother
Description
Date
Acquired
From Whom?
State How Acquired
(Gift, Purchase,
Inheritance or
Under a Will)
/2e4.(� c.
r,
If acquired by Purchase, were
funds used those of decedent
only or community property
funds with spouse?
4 /97'
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11. If a deceased child left descendents, give the following information:
RECORDED 4/30/2001 AT 09:00 AM REC# 1333602 BK# 0669 PG# 8224
LORETTA BAILIFF, CLERK of SWEETWATER COUNTY, WY Page 2 of 2
12. If decedent left no children or descendents of deceased children, then please furnish the following information:
a. Give names of parents of decedent:
b. Give names of brothers and sisters of decedent:
Y/?4
Relation
Address
Living /Dead
Name
c. Give names of children of deceased brother or sister:
Name of Child
Date of Death
Child of
Date of Birth
Address
Living /Dead
13. If decedent left no heirs covered by item 12 above, then attach a full and complete affidavit of heirship of said decedent in narrative form.
/4
14. Give location or description of homestead of decedent, as of date of death'
15. As to each tract of land or interest in land owned by the decedent at the time of his death which concerns this company, give the following information which
will be used primarily for the purpose of determining whether property was separate or community: (If space provided is insufficient, attach exhibit giving same
information as to each tract).
16. Here briefly state facts and circumstances (such as being a relative, a close friend, or attorney or agent for, decedent) which will show basis
and source of information given above.
STATE OF l
COUNTY OF �!�1 p SS.
Subscribed and sworn to before me this
o before me this day of
e
Affiant
94A 14 /vr>'� (//b4½, 75■1.t3r40
Ad ess
i..4
otary Public
trl the 9th day of March, 2001 before ire per
appeared,
be the person described in arld who executed the foregoing
the execution of the qwPb'RT G S FiH1 I and dead-
525
69 -5 -4-e/ day of
My commission expires
00040
to rre known to
t, and who acknowledged
of lawful age, being first duly swor on oath states:
,y,
That �1 g i
was personally and
A4 47 1
ndw te ehl acquain i 1 11 •t s T t! may ��ii urmg_,>Zlifetime:
that �L /J has read the above affidavit b 53
y .a 'f e•the'f therein are true and correct.
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i eTARY