HomeMy WebLinkAbout971617AFFIDAVIT FOR DISTRIBUTION
OF DECEDENT'S PERSONAL PROPERTY
PURSUANT TO W.S. 2 -1 -201
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
I, MELODIE ANN JOHNSON, being first duly sworn, on oath depose and
state that I am making this Affidavit pursuant to W.S. 2 -1 -201, on behalf of
myself, as distributee, as hereinafter set forth, that I make the following statements
in connection therewith:
1. That TANYA CHRISTENSEN became deceased on May 14, 2013,
in Billings, Yellowstone County, State of Montana, and was a resident of
Fairview, Lincoln County, State of Wyoming, at the time of her death; that said
decedent died intestate; that said decedent left Melodie Ann Johnson, as a
surviving child; that the sole and only party entitled to the estate of said decedent
is the distributee hereinafter named; a copy of the Certificate of Death of decedent
is attached hereto as Exhibit "A
2. That the value of the entire estate of said decedent, wherever located,
does not exceed $150,000.00.
3. That more than thirty (30) 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 following named distributee is the sole and only party
entitled to the estate of the decedent, that there are no other distributee of the
decedent having a right to succeed to any of the property of the decedent under
probate proceedings, and that therefore, the following named claiming distributee
is entitled to payment or delivery of all of the decedent's property:
Name Relationship
Melodie Ann Johnson Daughter
6. That among the assets owned by said decedent is the following:
a. Business Univera, Associate ID 1519546
b. 2006 Artic Fox trailer, VIN 4N15N242460125656
c. 2007 Chevrolet 350 Silverado pickup, VIN
w 1GCJK33D27F124227
Q w d 1981 GMC pickup, VIN 1GTGK24M6BF713941
O eh 2 e. 1999 Cherokee livestock trailer, VIN 4BSG1625X0002221
N w w f. 1980 Circle J 2 -horse trailer, VIN WT13046
ro v- (9 C Y g. Flat bed bumper pole trailer, license plate 12 -4914
M I■ Q Q ct
N a) a w h. 2 ponies Bella and Cracker
Z 0 i. Horse Pepsi, born in 2009
z Q 1- j. Horse Roanee, born in 2007
w w p k H Montana Soft Spikes, born in 2001, AQHA
W V Y 0 #4169993
II 0 1 TT_ Pure Cash Delight, 1 2000, /l71 A #3 932010
Zi Affidavit for Distribution
Page 1 of 2
020
m. Horse Time To Think Cash, born in 1989, AQHA
#2962065
n. Horse Star A Little Teri, born in 2011, AQHA #5390798
o. Horse Star A Phoebe, born in 2009, AQHA #5210701
p. Horse Heze Royal Te, born in 2007, AQHA pending
q. Horse Rezee, born in 2012, AQHA pending
r. Horse Smokey Jet Man, born in 2011, AQHA pending
s. Horse My Name Is Hildi, born in 2006, AQHA pending
7. That an executed copy of this Affidavit is being presented to the
transfer agent for the above listed asset in compliance with W.S. 2 -1 -201.
Furthermore, pursuant to W.S. 2 -1 -201, the depository for any income or interest
in the above entitled asset is hereby directed to pay any deposit or any funds in
said account that were in the name of the decedent, together with any interest and
dividends thereon, payable to distributee listed here.
CRYK> rAl. I_ •S;.
1_Ii1CUlI
c p
Name and Address Date of Birth Social Security No.
Melodie Ann Johnson 12/27/1979
EXECUTED this day of June, 2013.
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
SUBSCRIBED AND SWORN to before me, a Notarial Officer, by
MELODIE ANN JOHNSON this I day of June, 2013.
/vRY PUBLIC
Sit. +,fe of
in
Iss, 2014.
Wk ti
My Commission Expires:
MELODIE ANN JO SON
SSN: 636 -07 -1003
Address: P.O. Box 102
Auburn, WY 83111
Affidavit for Distribution
Page 2 of 2
NOTARIAL OFFICER
e 't
V V 2 0 4
%CERTIFICATION OF VITAL RECORD
FULL. NAME OF DECEASED:. Tanya .Christensen
DATEjOFDEATH: May 14, 2013
OTHER SIGNIFICANT CONDITIONS?
Not Recorded
NAME AND.ADDRESS OF CERTIFIER:
Randall Gibb P.O'Box 35100, Billings, Montana
DATE ISSUED: May '11, 2013 B
4::
This certifies that this document is a true duplication
Of the original rnfomation on file .with the Department
`of.Put lic Health and Human Services.
t
YELLOWSTONE COUNTY
CERTIFICATION OF A DEATH CERTIFICATE
Not Valid Unless Raised Seal Is Present
CIr "r d R
0 205
SEX: Femal=e
PLACE OF DEATH: BILLINGS
RACE: White
DATE. OF BIRTH: November. 12, 1956 BIRTHPLACE: Rexburg, Idaki'o
MOTHERS NAME: Arva Oho 1a Pulley
FATHER'S NAME: Carole. Peter Christensen
MARITAL STATUS: Divorced
SPOUSE:
SOCIAL.SECURITY.NUMSER VETERAN OF ARMED FORCES:
RESIDENCE: Bozeman, Montana
FUNERAL FACILITY: D:ah1- :Funeral Cremation Service
PLACE OF DISPOSITION: Dahl Crematory B'll.ings
Bi14ngs
METHOD OF DISPOSITION: Cremation
MANNER OF DEATH: Natural DATE FILED: May 17,
CAUSE OF DEATH: ONSET:
a. OVARIAN CANCER 1, `MONTH
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