HomeMy WebLinkAbout971329RECEIVED 6/6/2013 at 11:32 AM
RECEIVING 971329
BOOK: 813 PAGE: 99
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING
SS.
COUNTY OF LINCOLN
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF JAMES LARRY JENSEN
COMES NOW PENNY KAYE JENSEN, now known as PENNY KAYE JENSEN-
SANDBERG, after being sworn and under oath, hereby stating pursuant to Wyoming Statutes
2 -1 -201, which authorizes Affidavits of Distribution, as follows:
1. That James Larry Jensen, a resident of Afton, Wyoming, died on April 12, 2013.
An official copy of the Certificate of Death of James Larry Jensen is attached hereto.
2. That James Larry Jensen died testate. A copy of his Last Will and Testament,
dated February 8, 2007 is attached hereto.
hereby state:
009c9
3. That the Last Will and Testament of James Larry Jensen complies with the
requirements of Wyoming Statutes 2 -6 -114 and is therefore, a self proving will.
4. That the Last Will and Testament of James Larry Jensen provides that all of his
interests in property shall be distributed to "Penny Kaye Jensen
5. That, in accordance with the requirement of Wyoming Statutes 2- 1- 201(a), I
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF JAMES LARRY JENSEN
PAGE 1 OF 3
a. That the value of the entire estate of James Larry Jensen, wherever
located, less liens and encumbrances, does not exceed Two Hundred Thousand Dollars
($200,000.00).
b. That Thirty (30) days have elapsed since the death of James Larry Jensen.
c. That no application for appointment of a Personal Representative is
pending or has been granted in any jurisdiction.
d. That pursuant to the Last Will and Testament of James Larry Jensen, I,
Penny Kaye Jensen, am the sole beneficiary of his Estate. There are no other persons or
entities having a right to the assets of his Estate under probate proceedings.
6. That I hereby request that the following assets be transferred to and be titled in the
name of "Penny Kaye Jensen- Sandberg with the address of record being: "2461 Kennsington
Avenue, Salt Lake City, Utah 84108- 2415
a. a 1994 Suzuki MVP, VIN No. DD51T322228; the original Certificate of
Title, with the Assignment of Ownership completed, is attached hereto; and
of Title, with the Assignment of Ownership completed, is attached hereto.
DATED this 2 day of May, 2013.
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF JAMES LARRY JENSEN
PAGE 2 OF 3
tO AGO
b. a 2008 Ford PU, VIN No. 1FTSX21Y18EB53487; the original Certificate
ON THIS, the 28, day of May, 2013, PENNY KAYE JENSEN, now known as
PENNY KAYE JENSEN SANDBERG, affiant herein, appeared before me, and being duly
sworn under oath, affirmed that the facts stated in this Affidavit of Distribution are, to the best of
her knowledge, information, and belief, true and complete.
WITNESS my hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of State of
Lincoln Wyoming
My Commission Expires: July 16, 2015
My Commission expires:
611S
PEN r1 N• N
now ow
PE KA E JEN N-SANDBERG
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF JAMES LARRY JENSEN
PAGE 3 OF 3
V V J. V 1
Oit
Decedent: State File Number
Name: James Larry Jensen
Gender: Male: Social Security Number:
Date of Birth: October 10, 1945 Age at the Time of Death:
Date and. Place of Death:
Date of Death: April 12, 2013 County of Death:
City of Death: Afton
Location: Star Valley Medical Center 110 Hospital Lane
Additional Decedent Information:
Place of Birth: Afton, Wyoming
Residence: Afton, Wyoming
Marital Status: Divorced"
Armed Forces: Yes
Name of Father: James McKay Jensen
Name of Mother: Emma Ann Sanderson
Informant: Emma Ann Jensen Relationship: Mother
`Disposition:
Method of Disposition: Burial
Place of Disposition: Grover. Cemetery, Grover, Wyoming
Funeral Home or Facility:
Facility: Schwab Mortuary, Afton, Wyoming
Cause of Death:
The immediate .cause is listed an the first line followed by any underlying causes.
(a) Liver failure
(b) Alcoholic liver disease
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address;
-Date Filed:
CERTIFICATI
697159
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Renal failure dementia
Natural Death
April 23, 2013
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming,
DATE ISSUED:Thw April 25, 2013
Nth
t This Copy i s not valid unless prepared on paper with an engraved border.
Physician
Allen D. Carter, M.D.
11.0 Hospital Lane, PO Box 579, Afton, Wyoming, 83110
interval:
Time of Death: 18:25 (Actual)
a,„,4,5„ma.:,
J ames McBride 1
Deputy State Registrar
u 010 2
2013 001220
67 years
Lincoln
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111 txb C.4eot tm ent
of
JAMES LARRYJENSEN
I, James Larry Jensen, Testator herein, a resident of Lincoln County, Wyoming,
hereby revoke any prior Wills and Codicils made by me, and do hereby make, publish and
declare this to be my Last Will and Testament in the following manner:
FIRST: I declare that I am unmarried, and have no (0) children.
SECOND: I direct that all debts, administrative expenses, income, estate, inheritance,
or other death taxes (including any interest and penalties thereon) imposed
by any jurisdiction whatsoever by reason of my death upon or with respect
to any property includible in my estate for the purposes of any such taxes,
or upon or with respect to any person receiving any such property, whether
such property shall pass under or outside, or shall have passed outside, the
provisions of this Will, be paid from my residual estate without
apportionment as an expense of the administration thereof.
THIRD: I devise all of my personal and household effects used about my person
and my residence at the time of my death, in accordance with a written
statement or list which will be dated and in my handwriting and signed by
me, which I intend to leave at my death, and which will describe the items
and the devisees with reasonable certainty. If for any reason, no such
written statement or list is in existence at my death or if it fails to dispose
of all such property effectively, I devise such property, or that portion of it
not effectively disposed of, pursuant to the provisions of Clause FOURTH
hereof.
FOURTH: I hereby give, devise and bequeath all of my property, both real and
personal, to my adult sister, Penny Kaye Jensen, of Salt Lake City, U.T. If
Penny Kay Jensen predeceases me, I devise and bequeath my estate to my
adult sister, JoAnn Merritt, of Grover, Wyoming.
FIFTH: I appoint my sister, Penny Kaye Jensen, Personal Representatives of this
Will and direct that she not be required to give any bond or other security
for the faithful performance of duties iii this capacity.
SIXTH: The Personal Representatives named herein shall have all of the powers,
duties and obligations set forth and described in Wyoming Law. No bond
shall be required of the Personal Representatives herein named.
SEVENTH: I have designated the beneficiary of this Will as I desire. If any person
contests this Will, it is my wish that they be given no more than the
miniintun that the law allows.
IN WITNESS WHEREOF, I have hereunto set my hand to this Will and Testament,
this day of February, 2007.
JAMES LARYJEI<ISEN
Last Will and Testament, James Larry Jensen
Page 1 oft
1 l fi
G \Y I V r
The foregoing instrument consisting of two (2). pages, was subscribed by the said
James Larry Jensen, in our presence, and acknowledged by him to each of us, he at the
same time declaring said Instrument to be his LAST WILL AND TESTAMENT, and we,
at his request, have signed our names as witnesses to said Will in his presence, and in the
presence of each other, and placed our initials on the preceding pages, and have written
opposite our names our respective places of residence on this day of February,
2007.
WITNESS
WITNESS
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residing at /‘?t/ iete
residing at
residing at ,/OL d�
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Last Will and Testament, James Larry Jensen
Page 2 of
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5/10/2013
PENNY K JENSEN
Po BOX 753
ASTON WY 83110
FORD CR1=;r IT
P.O. Box 64400
Colorado Springs, CO 80962 -4400
1- 800 727 -7000
Account No: 43617816
Vehicle Owner:
LARRY JENSEN
ESTATE OF
PO BOX 753
ASTON WY 83110
Vehicle Information
Make: FORD
Year: 2008
Model: F250
ID No: 1FTSX21Y18EB53487
Original Lien Date: 03/14/2008
Original Amount Financed: $41,599.92
LIEN RELEASE.
Lienholder: Ford Motor Credit Company
This is to certify that Ford Motor Credit Company's security interest in the above
described vehicle has been satisfied by payment on 05/10/2013.
SHERIKA KING
Account Services Representative
Sworn to and subscribed before me this
DOC 524 -13 FC 3/25/2013
My Comrr�issiori�
(Notary Public embossed or rubber stamp seal)
This document can be presented at the Department of Motor Vehicles (or appropriate
state designated department) to obtain a lien -free title.
00109