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STATE OF WYOMING
COUNTY OF LINCOLN
AFFIDAVIT FOR DISTRIBUTION OF DECEDENT'S
PERSONAL PROPERTY PURSUANT TO W.S. �2 201
THE UNDERSIGNED, being first duly sworn, on oath deposes and states that she is
making this Affidavit pursuant to W.S. §2 -1 -201, on behalf of the decedent's estate, as hereinafter
set forth, and makes the following statements in connection therewith:
1. Arnold A. Gaub, was my friend and for many years last past he was a resident of
Lincoln County, Wyoming; that he died in San Luis Obispo County, California on or about February
9, 2013, as shown by the Certificate of Death attached hereto, marked Exhibit "A" and included
herein by reference; that said decedent died testate; that the distributee hereinafter named is the
beneficiary under his Last Will and Testament:
Heir
Sandra P. Gaub
ss.
Relationship Address
Friend 1600 South Valley View Blvd
Apt 2070
Las Vegas, NV 89102
2. That the value of the entire estate of said decedent, subject to Probate, at the time of
his death, wherever located, did not exceed $200,000.00.
3. That more than thirty days have elapsed since the date of death of the decedent.
4. That no application for the appointment of a personal representative of said decedent
is pending or has been granted in any jurisdiction.
5. That the above named distributee is the sole and only party entitled to the estate of the
decedent, that there are no other heirs of the decedent having a right to succeed to any of the property
of the decedent; that the following property of the deceased shall be distributed to Sandra P. Gaub:
a) 1971 Subaru 2 -Door Sedan VIN: K111L 10 059
b) 2002 Big T Utility Trailer VIN: 16VAX121021A51403
c) 2001 Mercedes ML4 VIN: 4JGAB72E31A274901
d) 100% Interest in Quantum Associates, Inc., a Wyoming Corporation
e) All checking /savings accounts
RECEIVED 4/19/2013 at 11:24 AM
RECEIVING 970541
BOOK: 809 PAGE: 610
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
EXECUTED this
STATE OF NEVADA
COUNTY OF C, (,t (IL
2013.
day of April, 2013.
Witness my hand and official seal.
VIVIANA TOBON
Notary Public State of Nevada
No. 05 98113 1
My Appt. Exp. Oct. 12, 2016
ss.
andra P. Gaub
Subscribed and sworn to before me by Sandra P. Gaub this gj day of April,
Notary Public
My commission expires /0 /Z /(Q
00 11
ARNOLD CERTIFICATI VITAL RECORD 't
1.NAMEOFOECEDENr- FRET 101.') 2. MIDDLE 3, LASTFem8y)
AUGUST GAUB
AKA A1.50 OWN 45- Include lull AKA (FIRST,
MIDDLE, 4. DATE OF BIRTH m4dd/cryy 5. AGE Yra. 1 M nn ONE H F I E5 HOURS 9. SEX
08/09/1935 77 MbM" M
S. BIRTH STATE/FOREIGN 50(.9157 10. SOCIAL SECURITY NUMBER 11. EVER IN U,S, ARMED 7 12, MAMALSTA1U45ROp' (KTs.4 454 7.01.7E OF DEATH mMdNOryy 8.5055 04 Han)
MONTANA u,c y DNORCED 02/09/2013 0840
13.Ed1(',A110N- l8lrltrWOgM 14/15. VMS DECEDENT HISPANIGMT)N0(,500 SSH AM1WRrlmbcq 1 �.16,OECEDENPS RACE r56ry Co 6.1
-UP 533Fm15 bFF vvdyhrl on 5.6
M �,rto CAUCASIAN
17. USUAL OCCUPA11ON- 12' olw69 for mw,o18N Do NOT`USEREr9E0` 15. KWO OI BUSINESS 0RWQUSTRY(i.8.,.pry 858,m d'035j4 48 6 66. FmpIOymyq agency, 55) 15,70450 IN OCCUPATION
REALTOR REAL ESTATE 25
M
20. DECEDENTS RESIDENCE (Slnand nom location)
601 01 ALPINE RD..
21, CITY 22, COUNTY/PROVINCE 23. ZIP CODE 24. YEARS IN COUNTY 25,8TATF)OREIGN 000470/
ALPINE ALPINE 83128 39 WY,.:.t.'"'"'...""
25. INFORMANT'S NAM REL 005651
SANDRA GAL1B ',FRIEND 1` 27.7IF0 S. O4/ISNS MNIJNGADDREI�W BL S beel VD #2 rymprr ,.'0/W 070 uh rn LA lib, 5Nn Mebend
89102
160 V ALLEY V7EG 'N\)
28. NAME OF SURVMNG(3P0U5E/3ROP' -FIRST 20, MIDDLE 30, tAST(3IRT1(NAMq 'ti
31, NAME OF 5THE5 A405NT -002t 32. MIDDLE 33. LAST 31.818121 STATE
CHRISTIAN r C. GRUB RUSSIA
35, NAME OF M0 R)PAR -1)8ST 36. MIDDLE 37. LAST (51811 NAME) j'(f 38. BIRTH STATE
LYDIA I MONTANA
33, DISPOSmoH 40. PLACE 0FFINAL olsposmos RESIDENCE
55/ 6/20 1600 S, VALLEY VIEW, BLVD #2070, LAS VEGAS, NV 89102
41, TYPE OF 015Sf118N 6) 42. SIGNATURE OF EMBALMER
til 46fL�EHSE NUMBER ►NOT EMBA
M, NAME OF MINERAL ESMBIJSHIAENT'' RLI
4CENSENUMBER 4&SIONATUREOF LOCAL AEGIS7RM 47.'CA15 mMd4f
KUEHL- NICOLAY x
ED68 PENNY BORENSTEIN, MD e ,1,6,?/15/2013 101. PLACE OFL]F x 702 IF HOSPITAL, SPECIPYOY4E 103. IFOIHER THAN HYISfTEAL, 09E
TWIN GITIEOO�' MMUNITY ®,p D'''' ®1 spke 0 Zr" °n3
101. COUNTY 7 /05 MCSIMAD�RESS 00 LOCATION WHE5EFOUNO(StrM and rOAAbV.6)362559 108
SAN LUIS OB1SP) 1100'LAS TABL/ S RD aid TE flg
N
107. CAUSE OFDEATH a V, LL t b +51 O 4$]yM,035038 t:a1bre MC1
Pot y5NSed 58,81 00NOT5651516YWn)e
ova* 3l*4 1 t150i82HfW1I5010 }811
r+rUscIFWY4bry em8, arvenblakr)d8dbnw81pu1Ynee18 tlra1bbpy. 00N01 01.1�M31�1
IMMEDIATE CAUSE w 'PR0STATECANCER (A 16 N
t YEARS
In death) (31) 700: BIOPSY PERFORMED/
Sequadl011y; NA 1
eaMNblu,NMry II N
NwBgTO cause
an L A 6NM
ns i ti1f 110. AUTOPSY PERFORMED?
UNDERLYING
CAUSE (dome or Y6 ®NO
INIWad 8 M 1
•r.S
rseu5Bq h deMR) LAST Nil 111.16EDNOEIEWAMINGCW5
112,ow555 A4w)c Jef Cosomoss CONTRIBUTING TO DEATH BUT NOT P52010NGINTILEUNOETLYING CAUSE GNEN )N 107
NONE
1f3, WAS OPEM710N PERFORMED FOR ANY CONODgNI*1REM 1010011
BIOPSY OF PELVIS AND BLADDER LEFT ki L, 055/20typeof Sn.nd1d4l1
134 FRWR
EEOYNrNV8T7FAR1
'TAL
11A108lWffl0' 101 8EB616MYI0a0I4IDfEC50N1l
HOii3) 115, SIGNA7URE AND 780.EOF 050/10(5 118. LICENSE NUMBER 117,01.7E 66/dy0050
R 1A
llE1COOEMDR /SW ®Ri0
SMT1EfN f03W01 Fula
o.ad.NnMndldaw .a.L.I
Da..S.,n op.
KOTA CHANDRA SHEKAR M.D.
gip p A�51899 02/13/2013
W m m/ddhcyy 0 ayy 118. TYPE ATTENDING PHYSICLWS NAME, MAILING ADDRESS, ZIP CODE KOTA CHANDRA SHEKAR M.D.
12/05/2011 02/04/2013 1310 LAS TABLAS RD STE 204, TEMPLETON, CA 93465
1131CHOFTTiBQNMI�pKtIDFN 4
H001i101A171EHJ 6VEMDRA�300 ®Ri7M11E0VL$SW� 120. INJURED ATWORK? 121, INNRYOAIE 56000ayy 12$8058 54 Hoorn)
MANNER OF DEATH III NMUd El AccidentII Hxddde 9lidtle III hsRd�Um delenlied YES U 1. Lx«
123. PLACE OF (e.3•• Na co!MINC11on NW, wooded Mee, etc.)
124. DESCRIBE H INJURY OCCURRED (Foams .1.3:11 man M IN
my)
sY)
125. LOCATION OF 1144U117 41
30.64 number, 1 d
r, or M01on, 825 city, end 5P)
Wi
123, SIGNATEOF CORONER /DEPUTY CORONER 127.551E mM04/aari 125. TYPE NAME, 7710.801 CORONER DEPUTY CORONER
�A,fi A 5 G D
REGISTRAR E ItlI�ItlIItlItlIlil�Itltl�tllllntlltlllllllllll�llltli$itl�ll @Inl FATEAUTH:/ CENSUSTpACT
'010001002277500'
CERTIFIED COPY OF VITAL RECORDS
STATE OF CALIFORNIA
COUNTY SAN LUIS OBISPO} SS'
This is a true and exact reproduction of the document officially registered and placed
bn file in the office of the SAN LUIS OBISPO COUNTY HEALTH DEPARTMENT.
This copy not valid unless prepared on engraved border displaying seal
STATE FILE NUMBER
SAN LUIS OBISPO, CALIFORNIA
CERTIFICA OF DEATH
STAIS IGEBIACK NKONLY/ YMIEOUTSORM31MIOM
FIP E P
3201340000254
LOCAL REGISTRATION NUMBER
Dr. 9nyBorenstein Health Officer
and signature of County Registrar.