HomeMy WebLinkAbout968597IN THE DISTRICT COURT OF THE THIRD JUDICIAL DISTRICT
IN AND FOR THE COUNTY OF LINCOLN, STATE OF WYOMING
IN THE MATTER OF DETERMINATION OF HEIRSHIP OF
SCOTT ALLEN BANTA, Deceased.
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
Probate \Banta \Affidavit of Distribution
AFFIDAVIT FOR DISTRIBUTION OF ESTATE
RECEIVED 12/19/2012 at 3:21 PM
RECEIVING 968597
BOOK: 801 PAGE: 101
JEANNE WAGNER
LINCOLN Y CLERK, KEMMERER, WY
Probate No.
00101
I, Shauna Ann Banta, being first duly sworn, on oath depose and state as follows:
1. That I am over the age of twenty -one (21) years.
2. That Scott Allen Banta is my ex- husband.
3. That my ex- husband, Scott Allen Banta died on the 11 day of August, 2012, in
Kemmerer, Lincoln County, Wyoming.
4. That my ex- husband, Scott Allen Banta did not have a Will upon his death and
accordingly died intestate.
5. That the only heirs of Scott Allen Banta are his minor children, Thomas Andrew
Banta and Michael Christopher Banta.
6. That I am the mother and only surviving parent of said minor children, Thomas
Andrew Banta and Michael Christopher Banta.
7. That I have been appointed conservator of the said minor children by Order
Appointing Conservator in the Third Judicial District Court in and for Lincoln
County, Wyoming and Letters of Conservatorship confirming my appointment have
been issued by that Court.
8. That Scott Allen Banta had no other children and was not remarried.
9. That the value of the entire estate of Scott Allen Banta, wherever located, does not
exceed two hundred thousand dollars ($200,000).
10. That thirty (30) days have elapsed since the date of the death of Scott Allen Banta.
11. That no application for appointment of a personal representative is pending or has
been granted in any jurisdiction regarding Scott Allen Banta.
12. That I as conservator of the said minor children am entitled to the payment or
delivery of the property of Scott Allen Banta and there are no other distributees of the
Decedent having a right to succeed to the property under probate proceedings.
13. That the personal property owned by Scott Allen Banta is as follows:
STATE OF WYOMING
COUNTY OF LINCOLN
1. Check #18488431 in the sum of $191.67 from Merrill Lynch;
2. Check #2464 in the sum of $692.30 from Westmoreland Kemmerer, Inc.;
3. Check #1160574 in the sum of $156.41 from Questar Gas Company;
4. Check #300079800 in the sum of $3.13 from Sirius XM Radio Inc.;
5. Checking Account #0260146407;
6. 1984 Ford F -150 4x4 Diesel Truck; VIN 1FTHF2610GPA94394; and
7. Life Insurance Policy.
14. That if any other personal property is located that is not identified above, I as the
conservator of the minor children am entitled to that property.
Dated this 11�
day of December, 2012.
1
ss.
I, Shauna Ann Banta being first duly sworn, states that I am the affiant noted above, that
I have read the same, know the contents thereof, and that the statements contained therein are true.
Subscribed and sworn before me this
Probate \Banta \Affidavit of Distribution 2
day of December, 2012.
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LINCOLN WYOMING
NOTARY PUBLIC WIC
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DEPARTMENT OF HEALTH
CERTIFICATE OF :DEATH
Decedent: State File Number:
Name: Scott Allen Banta
Gender: Male
Date of Birth: February 20, 1978
:Date and Place of Death:
Date of Death: August 11, 2012
City of Death: Kemmerer
Location: US: Hwy. 30! MP 62
Additional Decedent Information:
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Facility:
Cause of Death,
The immediatecuse is listed on the first line followed by any underlying causes.
(a) Blunt trauma to torso and legs
(b) Motor Vehicle Accident
Other Significant Intoxicated Victim had a BAC of .245%
Conditions:
Manner of Death: Accident Time of Death:
Injury Information:.
Date Of Injury:
Injury At Work?
Location:
Description:
Certifier:
Type:
Name:
Address:
Date Filed:
STATE OF WYOMING
Torrington, Wyoming
Qpal, Wyoming
Divorced
No
Andrew E. Banta
Mary E Eaton
Mary Banta
Cremation
UFD Cret ation Center, SoutlyJordan, Utah
Ball Family Chapel, Evanston, Wyoming
August 11, 2012 (Actual) Time Of Injury: 05:35 (Actual)
No
US Hwy. 30 MP 62, Kemmerer, Wyoming
Head on collision with. a Semi trailer traveling in the opposite direction. Blunt trauma to torso and
legs.
Coroner
Cliff Boyd, Deputy
274 N St, Box 57, Grover, Wyoming, 83122
September 11, 2012
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming,
DATE ISSUED:Wednesday, September 12, 2012
S(:
v,J` This copy is not prepared on paper with att engraved border.
Relationship:
0
2012- 002697
Social Security Number:
Age at the Time of Death: 34 years
County of Death: Lincoln
Mother
05 :35 (Actual)
James McBride
Deputy State Registrar
fp
CERTIFICATION OF VITAL RECORD''