HomeMy WebLinkAbout966245B
I f FWEST"
NOTICE TO BANK:
I /We [Enter name(s)]
MUST BE FILED WITH COUNTY CLERK AND BANK MUST RECEIVE .A CERTIFIED COPY
PRIOR TO ANY
G°v DISTRIBUTION OF ASSETS. I /l 0 1
60 1 J c /l4/Yef /e y 1- /7 /ii W 7 !''te tF (individually
and jointly "Affiant whose address(es) is /are: (Attach additional
sheets as needed)
'f eA,/ S l
t en y
,4 �'�f 4, [�1/� °2 ),J 217 1/ 4e12.4) ,//�1. /34/
declare to Bank of the West "Bank that the following is true and correct:
1. (Name of Deceased) Cee V" e W 7 .6fetlC (the "decedent') died in the City of
on (Date) y7
2. At least thirty (30) days have elapsed since the death of the decedent,` as shown in a certified copy of the decedent's death
certificate attached to this affidavit.
3. No application for appointment of a personal representative is pending or has been granted in any jurisdiction_
4. The current value of the decedent's entire estate, wherever located, less liens and encumbrances, does not exceed two hundred
thousand dollars ($200,000).
5. The claiming distributee(s) are entitled to payment or delivery of the property by virtue of the following facts concerning the
distributee's relationship to the decedent: Distributee(s) are: [Check appropriate box(es)]: Parent(s); Spouse; Child(ren);
Grandchild(ren); Sibling(s); J Child(ren) of Sibling(s); Aunt(s)/Uncle(s); Heir(s) under will; Heir(s) at law;
Trustee of trust taking under a pour -over will; Other Describe:
There are no other distributees of the decedent having a right to succeed to the property under probate proceedings.
6. At the time of the death of the decedent, the decedent was the owner of certain personal property held by Bank of the West, which
personal property is described as follows:
(a) Funds on deposit in the aggregate sum of f/ r'/ee v#4/54 /i"-vAiIAGIVJjje �y 1-/ i e x�%� e
772 7 7 in the following accounts:
Branch Name
C4
(b) Personal property situated in safe deposit box or vault no.
Branch Name and State)
(c) The decedent's interest in: (Describe)
RECEIVED 8/16/2012 at 11:32 AM
RECEIVING 966245
BOOK: 791 PAGE: 682
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
County of Jte/Pefjj State of
AFFIDAVIT UNDER PENALTY OF PERJURY FOR RELEASE OF ACCOUNT
OR PERSONAL PROPERTY WITHOUT COURT ADMINISTRATION
WYOMING STATUES SECTION 2 -1 -201 ET SEQ.
(FOR ESTATES WITH A TOTAL VALUE OF 5200,000 OR LESS)
,f
City /State Account No. Amount
(continued)
Dollars
or held in safekeeping at this branch; (Enter
030 -05180 (Rev. 07/11)
Name and Address
Relationship to Decedent
Proportion Due Each Distributee
1) 6e r7 r j,$///
,r,jIii/
0
6 e ff vjI
//0.5 i'4445 .S -ci
c✓'ee,v i'l /m, IA-/ r.2_735
2) /4,, g k// II `fre4dM1
fV� 4e«
ef7 f
337 /k e,, 7 /PIIP,✓,y
/i(e414ftwo, wi r3A7/
3)
4)
7. The affiant is entitled to payment or delivery of the described property, has the relationship described below and requests that the
described property be paid, delivered or transferred to affiant(s) directed as follows:
Page 2 of 2
8. Affiant is the successor to the decedent's interest in the described property or is authorized to act on behalf of the successor of the
decedent with respect to the decedent's interest in the described property and no other person has a superior right to the interest of
the decedent in the described property.
9. If there is more than one affiant, all statements in this Affidavit are made individually and jointly.
10. In consideration for Bank's honoring this Affidavit, Affiant(s) agree(s) that Bank cannot be held liable for giving
Affiant(s) the money and /or property described in paragraph 6 and agree(s) to indemnify Bank and hold Bank harmless
against all liability, loss, costs, damages or expenses, including attorneys fees, which Bank may incur by reason of its
honoring this Affidavit. A receipt for the payment by each of the distributees shall constitute a valid and sufficient release and
discharge of Bank of the payment made.
11. Affiant represents and warrants that Affiant has been advised to consult with legal counsel prior to executing this
Affidavit and that Affiant has had the opportunity to consult with legal counsel and has obtained such legal guidance as
Affiant has deemed appropriate prior to executing this Affidavit.
12. Each affiant affirms or declares under penalty of perjury under the laws of the State of Wyoming that the foregoing is true and
correct.
This Affidavit is executed on /1 f/, i ikt,/ C "g5/ 20 2 in the City of
State of a /4 1'/1 -5 77
MUST BE EXECUTED BY J 1 DISTRIBUTEES.
q
STATE OF vJ y bd
L n
COUNTY OF h c o I r l
Affidavit Small Estate
PriA3u 20 before me, the undersigned, a Notary Public in and for said State, personally
On l
appeared C YiaKe•� an a 14 G�-d"Y V WO-ke. e i s personally
known to me (or prbVed to me on the basis of satisfactory evidence to be the person(s) whose name(s)is /are subscribed to the within
instrument and acknowledged to me that he /she /they executed the same in his/her /their authorized capacity(ieE), and by his/her /their
signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS
Signature:
and and offic'_1 seal.
ng
(Seal)
igna
Signature
Stacy A. Werner Notary Public
County of e., State of
Lincoln ??rx,f5i?; Wyoming
My Commission Expires_f f7/
r ^A ''ice_ a'''1'ti ;••.U-f *r�.v.•.R is Y1Y'+iti
13 l3 l3 0 e_?
030 -05180 (Rev. 07/11)
1H—C (--4,FP-141
ff;
Decedent:
Name:
Gender:
Date of Birth:
Certifier:
Type
Name:
Address:
Date Filed
Other Significant\
Conditions:
Manner of Death:
17' k44 040 1 7WP814
ICATION OF VITAL RECORD
STATE OF WYOMING
DEPARTMENT OF HEALTH
.CERTIFICATE OF DEATH
George WilliamDrube
Male
December 28,.1927
Natural Death
This copyjs not valid funless prepared on paper with attengravedborder.
Date and Place of Death:
Date of Death: April 26, 2012
City of Death: Rock Springs
Location: '222 GatewaYBouleVardSpace 146,
This is a true certification of the document on file in the office of Vital
Statistics Servilces;:pheyenne, Wyoming,
s8uEbV.Vednesday;:: May 02, 20.12::
DATEI
State File Number:
soci0.§ecuiltyNunter:
Age at the Time of Death:
COunty tif Death:
Additional becedent
Place of Birth: Cheyenne, Wyoming
„esidence.. Rock Springs, yyyotning
Marital Status: Never Married
Armed Forces: No
Name of Father: Herman Otto Drube
Name of Mother: Elizabeth L. dtien
Informant: Harvey H. Wakefield Relationship:
i;iepositipri:
Method of Disposition: Cremaflori
Place of Disposition: White Mountain Crematery, Rock Springs, Wyoming
Funeral Home or FacitIty:
Facility: Vase Wyoming'
The immediate cause Is listed on the first line followedPyanyunderlying causes.,.
(a) Acute Congestive Heart Failure
(I?) Coronary Sclerotic Heart Disease
Coroner
Travis Sanders, Deputy Corciner
.421 B Street Rock..Springe 82901
May 01, 2012...
Nephew
45:45 (Approximate)
James McBride
2012-001186
520-26-7017
84 years
Interval:
Minutes
Deputy State Registrar
Svveetvvater
AMA
0 0 6 8