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HomeMy WebLinkAbout973728STATE OF COLORADO SS. COUNTY OF LARIMER AFFIDAVIT OF DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF ROBERT W. WHITNEY COMES NOW DONALD E. WHITNEY, after being sworn and under oath, hereby stating pursuant to Wyoming Statutes 2 -1 -201, which authorizes Affidavits of Distribution, as follows: 1. That Robert W. Whitney, a resident of Star Valley Ranch, Wyoming, died on August 27, 2013. An official copy of the Certificate of Death issued by the State of Colorado for Robert W. Whitney is attached hereto. 2. That Robert W. Whitney died testate. A copy of his Last Will and Testament, dated May 10, 2002, is attached hereto. 3. That the Last Will and Testament of Robert W. Whitney 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 Robert W. Whitney provides that all of his interests in his business property shall be distributed to Donald E. Whitney as the surviving Trustee of The Robert Warren Whitney Living Trust dated May 10, 2002. AFFIDAVIT OF DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF ROBERT W. WHITNEY PAGE 1 OF 3 RECEIVED 10/16/2013 at 10:01 AM RECEIVING 973728 BOOK: 822 PAGE: 419 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 4419 hereby state: 5. That, in accordance with the requirement of Wyoming Statutes 2- 1- 201(a), I 0 4 2 0 a. That the value of the entire estate of Robert W. Whitney, 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 Robert W. Whitney. 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 Robert W. Whitney, I, Donald E. Whitney, surviving Trustee, 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 "Donald E. Whitney, Trustee with the address of record being: "2873 Crooked Wash Drive, Loveland, Colorado 80538- 7272 a. 1987 Cadillac Sedan, VIN No. 1G6CD5189H4270578; and b. 1985 Welca Box, VIN No. C200C19F4003023; DATED this day of October, 2013. AFFIDAVIT OF DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF ROBERT W. WHITNEY PAGE 2 OF 3 ON THIS, the WITNESS my hand and official seal. My Commission expires: DONALD E. WHI TNEY day of October, 2013, DONALD E. WHITNEY, 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 his knowledge, information, and belief, true and complete. AFFIDAVIT OF DISTRIBUTION PURSUANT TO WYOMING STATUTES 2 -1 -201 FOR THE ESTATE OF ROBERT W. WHITNEY PAGE 3 OF 3 1 0/ ATV NOTARY PURL C Arfi CHANDRA B C STATE tdO OF COLORADO NOTARY to 01540644 i3, 2014 COMMiS51ON JANUARY_ 0421 1: DECEDENTS NAME (First, Middle, Last) Robert Warren WHITNEY 2. SEX; Male o iru t. (Month, t INUtl MtH DATE OF DEATH (Month, Day,:Year) August 27, 2013 4. SOCIAL SECURITY NUMBER 5a. AGE 91 5b. UNDER. 11 YEAR 5c. UNDER 1 PAY 6. DATE OF BIRTH 7. BIRTHPLACE (City and State or Foreign Country) Windsor, Ontario, Canada Ys 1(5 Mina Monts Day Year April 19 1922 8. WAS DECEDENT EVER IN U.S. ARMED FORCES? J Yes No 9a. PLACE OF DEATH (Check only one) HOSPITAL: OTHER: 0 g W Assisted Living/Nursing Nursin Nome Hospice Decedent's ResitlenCe inpatient ER/Outpatient 0 OOA 0 Other (Specify) 9b. FACILITY NAME (If: not Institution,: give street and number) Pathways Hospice Care Center 9c. CITY, TOWN, OR LOOAI ION OF DEATH Loveland;: 9d, COUN 1y OF DEATh Larimer 10a. DECEDENTS USUAL OCCUPATION (Give kind of work done during most of working life. Do NOT use retired) i Self- Employed' N 1 Architect 11. MARITAL S �TUS Married Never Marred widowaa in Divorced Unknowq 12. SPOUSE (If wife, give maiden r fain) 13a. RESIDENCE l- STATE :13b. Wyoming COUNTY Lincoln 13c. CITY, TOWN, OR LOCATION Thayne 13cti STREET AND NUMBER 2391 Muddy String Road 13e. INSIDE CITY LIMITS? Ye 1 s E l s N 13f. ZIP CODE $312 14. WAS DECEDENT OF HISPANIC ORIGIN? If "1'es", specif}«Cuban, Mexican, Puerto Rican, etc.) No Yes Sdecl y. 15. RACE American Indian, Week, While, etc. (Specify) l Whit 16. EDUCATION: (Specify only highest grade �mplMd Elementary or sewnaary (0 12) legs e (1� is or 17f):; 16 i 17. FATHER :NAME (Fast, Middle, Last) Clarence :Whitney 18. MOTHER NAME(First, Middle, Ma n) Gertrude Taylor 9-INFORMANT NAME and relationship to deceased Donald Whitney Brother 20a. METHOD OFDISPOSITION Resomelwn BnrlevEntombment CICremalion Removal from Stale Donation Other (Specify) 20b, PLACE OF DISPOSITION (Name of cemetery, crelnatory, or other 'place),, Viegtit Cremation .Center 20c. LOCATION City oOTown, State Ioveland, Colorado 21a. SIGNATURE OF LINE DIRECTOR OR PERSON ACTING AS SUCH si re /./41&47; 215 NAME AND ADDRESS OF FACILITY Viegut Funeral Home T616 1V. Lincoln Ave., Loveland, Co 80538 22a REGISTRAR'S SIGNATURE Signaiure t--- I 22b. DATE FILED (Month, Da y War) August' 30 a 2013 23 TIME OF DEATH 3:05 CX AM 0 PM T CI .Milt 24. DATE SSFIEPIiON®U DEAD Month f11III///// Day Year Time August 27 2013'. 3 :05 la AM 0 PM Milt 25. WAS CORONA NOTIFIED? DI Yes El No To BE COMPLETED I GNING PHYSICIAN TO GE COMPLETEO BY CORONER 26a. To the best of place, and due to taus Signature ledge, death occurred at the time, date and (s) and manner as stated. amp 11h/) 1 I lX� ,(,t��M 0 G 27a.On the basis of examination and/or investigation, in my opinion death occurred at the time, date and place, and due lb the cause(s) and manner as stated. SIgnature I Corone ASSOGDeputyCoroner 2 6b. DATE SIGNED (MOO, Day, v_ 1 5 275.DATESIGNED :(Month Day year) 26c. NAME, AND MAILING ADDRESS OF SIGNING PH CAN David K. Allen M.D. 305 Carpenter Rd. Ft. Collins, CO 80525 27c. NAME AND COUNTY, 28.NAMEOF ATTENDING PHYSICIAN IF OTHER THAN SIGNING PHYSICIAN S. MANNER OF DEATH N Natural ['Accident []Suicide Homicide Pending Invehtlgatiom. Undetermined 'B. sr rn 'I on1 30. DID TOBACCO USE CONTRIBUTE TO DEATH Yes 50 Probably 1 A UnkhOwn r' 1 31. IF FEMALE: Not Regnant within last year Not pregnant, but pregnant 43 days to 1 ❑Pregnant Memo of death year belOre death []Not pregnant, but pregnant within 42 days of death Unknown If pregnant within the past year IP .ay,':. 11 32e v. M e JU DAM D PM 0 Milt 32c.INJU ATW.RK ?32..s Yes 0 No I: err aT R• a i PLACEOF INJURY At home, farm, street, factory, office building, etc. (Specify) 32f LOCATION INJURED (Street and Number or Rural Route Number, City, County, State) 33. IMMEDIATE CAUSE enter only one cause per line fo (b), Part 1. (a) 4 �V1� 1 Conditions if any a (c). Do not enter mode of dying (e.g. Cardiac or Respiratory Attest) alone. Interval etween onset and death I Minh gave rise DUE OR AS A CONSEQUENCE 01' to immediate'. cause stating the (lc) underlying cause d ie m erve .Iwe set and ea DUE TO OR ASA CONSEQUENCE OF: last (c). (cI' Interval between onset and death Part 2; OTHER SIGNIFICANT CONDITIONS- Conditions contributing to death but rat related to cause in Part 1 34. AUTOPSY. ❑Yes ®No 35. RYES, er we ns endignsed in tlefermining ceu(:e of tlea ider Yes 0 No 4 �y, ee iY\ X W Z 0 rfi Z U a. D '�Sts''al0P 14 Iy a .SA 4 ip! "Air iii li 'WA i fr f II W. r L U ii 4 X41 CERTIFICATIO TAL RECORD STATE OF COLORADO COLORADO DEPARTMENT OF PUBLIC HEALTH AND`ENVIRONMENT HOLD TO LIGHT TO VIEW WATERMARK ATE ISSUED AUG 3 0 2013 STATE OF COLORADO CERTIFICATE nF i 'FH19')S ATRElE CERTIFICATION OF NAME-AND-FACTS AS RECORDED IN THIS OFFICE. Do not accept unless prepared on security paper with engraved border displaying the Colorado state seal and signature of the Registrar. PENALTY BY LAW, Section 25 -2 -118, Colorado Revised Statutes, 1982, if a person alters, us :attempts to use or furnishes to another for deceptive use any vital statistics record. NOT VALID IF.. PHOTOCOPIED. R RONALD S. HYMAN STATE REGISTRAR 11111111111 REV 01/07 0422 5. 4 I, ROBERT WARREN WHITNEY, of Freedom, Wyoming, make this Will and revoke all of my prior wills and codicils. The names of my siblings are: Last Will and Testament of ROBERT WARREN WHITNEY Article One My Family Donald Edward Whitney, born, March 13, 1931 Eleanor Mary Olin, born, September 17, 1924 Helen Gertude Greenwood, born, September 8, 1920 Margaret Doris DeMerchant, born, July 20, 1918 All references to my siblings, or beneficiaries, are to them. Section 1. Personal Memorandum Article Two Distribution of My Personal Effects Robert Warren Whitney Last Will Page 1 of 4 0 423 If permitted under the laws of Wyoming, I give all of my tangible personal property including, but not limited to, jewelry, books, clothing, pictures, works of art, paintings, coins, tools (mechanical, electrical carpentry and architectural) music, son books, music tapes, furniture, furnishings, artifacts, items of hobbies, etc., including other articles of household or personal use, in accordance with any written, signed, and dated memorandum left by me which directs the distribution of my personal effects. Lowry Citation Organ, 1964 Dodge Dart, 1987 Cadillac Deville and 2002 Cadillac Seville SLS. Should I leave multiple written memorandums which conflict as to the disposition of any item of my tangible personal property, that memorandum which is dated last shall control as to any items which may be in conflict. Section 2. Distribution of Personal Effects to Family 042 All of my tangible personal property not distributed by memorandum shall be distributed to my siblings or beneficiaries in equal shares. Any decision made by my personal representative(s) with respect to either the selection or sale of my property shall be final and binding on my siblings or beneficiaries. Section 3. Business Property Excluded Any of my tangible personal property that I used in a business shall not e distributed under this Article. Article Three The Remainder of My Property Section 1. Pour -Over to My Living Trust The remainder of my property shall be distributed to ROBERT WARREN WHITNEY, of his successor in trust, under THE ROBERT WARREN WHITNEY LIVING TRUST, and any amendments thereto, dated May 10, 2002. Section 2. Alternate Disposition If my living trust is not in effect at my death, I give all of my property to those of my living siblings, per stirpes. This includes an equal share of one -half (1/2) interest in my house and lot located at Star Valley Ranch, Plat 10, Lot 77. The property subject to distribution under this Article shall be the land, personal property, money and all of the property of any value which I own. Article Four Powers of my Personal Representatives(s) My personal representative(s) shall have the power to perform all acts reasonably necessary to adminigter my estate, a.c well ac any pnwerg get forth in the gtatiiec in th State of Wy riming relating to the powers of fiduciaries. Rob w -r Whitney! T cut W? Pane 2 of 4 Article Five Payment of Expenses and Taxes and Tax Election Section 1. Cooperating with the Trustee(s) of My Living Trust I direct my personal representative(s) to consult with the trustee(s) of my living trust to determine whether any expense or tax shall be paid from my trust or from my estate. Section 2. Manner of Payment and Tax Elections All taxes, other than any generation- skipping taxes, imposed as a result of my death which are not paid by the trustee(s) of my living trust shall be paid from my estate without apportionment, and without contribution from any person. My personal representative(s) in their sole and absolute discretion, may exercise any available elections with regard to any state or federal tax laws. My personal representative(s) in their sole and absolute discretion may elect to have all, none, or part of the property comprising my adjusted gross estate for federal estate tax purposes qualify for the federal estate tax marital deduction as qualified terminable interest property under Section 20956(b)(7) of the Internal Revenue Code of 1954, as amended. My personal representative(s) shall not be liable to any person for decisions made in good faith under this Section. Article Six Appointment of Personal Representative(s) I appoint the following person to be my personal representative: Donald Edward Whitney. I direct that my personal representative not be required to furnish bond, surety or other security. I have signed this Will which consists of four pages on May 10, 2002. 0425 ROBERT WARREN WHITNEY R ,ert T+Inrroyt Witih'ev Last Will Pc.7e 3 of 4 The foregoing Will 'was, on the day and year written above, published and declared by the Testator in our presence to be his last Will. We, in his presence and at his request, and in the presence of ea other, have attested the same and have signed our names as attesting witnesses. We declare that at the time of our attestation of this Will, the Testator was, according to our best knowledge and belief, of sound mind and memory and under no undue duress or constraint. 6i/ j /4714, -.2/ Witness 727, Witness STATE OF WYOMING SS. COUNTY OF LINCOLN Subscribed, sworn to and acknowledged efore me y Robert Warren Whitney the Te t ato and subscribed and sworn to before me by Y May, r/ Gl�4 4:5 and li a A S/l ci 1 witnesses, this 10 day of Ma 2002. 0 My Commission Expires: Address /76s gc- flavae 41/4a 09K; )742.s- Addre Rolbrt T 7 ,V'YtiP!tri Last iLl1 P/$vo 4 o"4 r gO OTARY PUBLIC HEIDI BROWN f4OTAFIY PUBLIC County of State oi Lincoln Wyoming My Commission Expires 8-5•05 426 it THE JOINT LIVING TRUST AGREEMENT OF 0 ERT WA' N WH TTNEY This Joint Living Trust Agreement, dated May 10 2002 is by and among: ROBERT WARREN WHITNEY Settlor and ROBERT WARREN WHITNEY Trustee ©427 ARTICLE 7: WAIVER OF DUTIES OF PERSONS 1 EALING WITH THE TRUSTEE(S). No person dealing with the Trustee(s) shall be obligated to see to the application of any monies, securities, or other properties paid or delivered to the Trustee(s), or to inquire into the expediency or propriety of any transaction, or the authority of the Trustee(s) to enter into and consummate the same upon such terms as the trustee(s) may deem advisable. ARTICLE 8: CONSOLIDATION OF TRUST SHARES For convenience of administration and investments, the Trustee(s) for the trust are authorized to hold the several shares of the trust estate in a common fund, dividing the income proportionately among them, to assign an undivided interest in the several shares, and to make joint investments of the funds belonging to them. ARTICLE 9: TRUSTEE(S) If the Trustee(s) herein named, ROBERT WARREN WHITNEY shall for any reason cease to act, be unable to act by reason of mental or physical disability, or die, then in such event Donald Edward Whitney shall act as successor trustee(s) and then Scott Whitney, son of Donald Edward, should the former be disabled or dead, shall act as successor trustee(s). ARTICLE 10: ACCOUNTING Each year during the existence of the trust estate the Trustee(s) may render to the beneficiaries of the trust a statement setting forth the Trustee(s) receipts and disbursements as Trustee(s) hereunder. ARTICLE 11: TAXES 0428 If any inheritance, estate, transfer, or succession tax is levied against the estate of any beneficiary of this trust on account of this trust, the Trustee(s) shall pay such taxes of the principal of the trust or make provision for such payment, without charging such payment against the interest of the several beneficiaries of the trust. Except as otherwise provided herein, if any such tax is assessed in part by reason of this trust and in part by reason of other properties, the Trustee(s) shall pay the portion of the total tax which the assets of this trust bear to the total properties so taxed, taking into consideration the deductions, exemptions, and other factors which the Trustee(s) deem pertinent. For purposes of this Article 11 the judgment of the Trustee(s) as to what portion of such tax the Trustee(s) should pay, and the computation of such portion shall be conclusive upon all persons interested in this trust. This Article shall not apply to the levy of income taxes against any beneficiary of the trust. ARTICLE 18: COUNTERPARTS This document may be executed in several counterparts, each of which shall be deemed to be an original. ARTICLE 19: ACCEPTANCE OF TRUST The Trustee(s) hereby accept the trust created by this document and agree to effectuate the provisions hereof to the best of the Trustee(s) ability but the Trustee(s) shall not be responsible for any mistake in the Trustee(s) judgment or for any decrease in value of the trust estate resulting from any cause whatsoever. The Trustee(s) shall not be required to give any bond or other security for the faithful performance of the Trustee(s) duties hereunder. ARTICLE 20: PROTECTIVE CLAUSE To the fullest extent permitted by law, the interests of all of the beneficiaries in the various trusts and trust property subject to this agreement shall not be alienated, pledged, anticipated, assigned, or encumbered unless specifically authorized by the terms of this agreement. ARTICLE 21: CONTEST CLAUSE If any beneficiary, other than the settlor, shall in any manner, directly or indirectly, attempt to contest or oppose the validity of this agreement, including any amendments thereto, or commences or prosecutes any legal proceedings to set aside this agreement, then in such event such beneficiary shall forfeit his or her share, cease to have any right or interest in the trust property, and shall be deemed to have predeceased the Settlor. IN WITNESS WHEREOF, the parties have executed this instrument on the date and year first above written. ZeL) o ROBERT WARREN WHITNEY, Settlor !:'.a,:ebey 1 r'li.di _2 uj i- ROBERT WARREN WHITNEY, Trustee 0429 STATE OF WYOMING COUNTY OF LINCOLN SS On this 10 day of May, 2002, before me, the undersigned, a Notary Public, in and for the State of Wyoming, personally appeared before me ROBERT WARREN WHITNEY signer of the above instrument, who duly acknowledged to me that he executed the same as Settlor and Trustee of the ROBERT WARREN WHITNEY LIVING TRUST, whose name is subscribed to the within Trust as trustee, and acknowledged to that he executed the same as Trustee. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal, the day and year in this certificate first above written. My Commission Expires: ,S_ dS 7/ FaS d i o i•r (A- TARY PUBLIC HEIDI BROWN NOTARY PUBLIC County of SNP= State of Lincoln Wyoming My Commission Expires 8-5-05 0430 MV -301 (01/10) WYOMING TITLE NUMBER 12- 285225 OFFICE OF COU TY CLERK LINCOLN COUNTY KEMMERER, WY WATERCRAFT CODES FEE 55�pppp DATEI1gOED Vessel Type 1- Canoe /Kayak 6- Houseboat 2 -Open Motorboat 7- Personal Watercraft (Jet Ski) 3- Rowboat 8 -Sail Boat 4 -Cabin Motorboat 9 -Other 5- Pontoon Boat Hull Material 1-Fiberglass 6 -Rigid Hull Inflatable 2- Aluminum 7 -Other 3 -Wood 4 -Steel 5- RubberNinyl /Canvas Propulsion Type Engine Drive Type 1- Propeller 2 -Sail 3- Waterjet 4- Airthrust 5- Manual 1. Outboard 2- Inboard 3- Inboard/Stern Drive 04 3 1 08/21/2013 V;;11.00' C w. IN WITNESS WHEREOF, 1 have he this Cerffi- cate to be signed and the official Seal' Of this officg, to be placed thereon. ��.S w i I I I n� m inty Jerk yam I j� g�egi y r r I o :i —a eni'ty 1 Released SEAL) Qow ty Cletk Deputy Second Lien Released 4Date) „STATq P�,k� ciE)Ih ita NO. 22 -88004 VEHICLE IDErg HULL 1DENTIFIC,A116N' NO;;; 1 6055189H427 05 41:11Z SELLER WHITNEY, HULL MATRL,, 7 ODO /U R VESSEL L'E )(GTH 0 RROPLSN PUROH DA; 08/15/2013 May WV!! .$21,334.00 OWNER WHITNEY, ROBERT 2873: CROOKED WASH DR. LOVELAND CO 80538;; 'Whitney H FOR COUNTY CLERK'S 1t�ut' „tl'. CERTIFICATE OF TITLE BOD Y 'STYLE VEHICLE BRA Over 10 YearslEzeinpt' LOOK FOR OkcitE WATERMARK IN SHEET NOT VALID IF ALTERED OR CHANGED 5404567 _THIS DOCUMENT IS VOID IF ALTERED THIS, DOCUMENT MUST BE SIGNED BY ALL SELLERS AND BUYERS 4MENT OF OWNERSHIP T S IS TO BE FILLER IN BY THE SELLER ND DELIVERED TO THE PURCHASER AT THE TIME THE VEHICLE IS DELIVERED. PURCHASER MUST MAKE APPLICATION wsu NE IQERTIFIL�ATE,OF TIN AE, N N E COUNTY ER„ 001O N AL- A E I v half �G (Must be printed) IDRE�s 2 8 ?3 W S -H D RI V� 'Tr I �1,'.r v tv ulr STREET LavaLAl(O Cotda400. 805 7 2.'72 dITY j 'a ODOMETER DISCLOSURE STATEMENT FERAL AND STATE REGULATIONS REQUIRE',you to state, the mileage tipolf;transfer of ownership of moo a rvehicle Failure 10 complete or providing a false statement may esu�lt In „fines and/or impr)sohment. F ''u hereby state that the odometer now reads. O f f� (No tenths)miles a d o t e best 4 7 DONALD W 1+ i Th' m p ohmy' knowledge, it reflectsthe statement checked below: u s: n. e the actual mileage of the vehicle, or n the amount of mileage in excess of mechanical :limits; or, f, W the 'pdometerleadlr) s f NOT th actua yyam�,, TER„D SCREP I/WE uo hereby certify and warrant that' -I/WE am /are the true and IaWful owner(s) of the vehicle' described herein and .further warrant'ha �e bens arid e ances 1d he l t �,�''�n liens ar dencumbrances against the vehicle herein described and hereby transfer and convey all rights; title and interest that 1/WE haven !r the vehlple° ,r be d(, to the a.oY wn ¢L. individual(s): and if the vehicle herein described is a mobile home, do hereby certify that all taxes due for [he preceding and current year on the mobile nom' have been pad. M1t d _,,„d646;',: .l'IOV1)f�E tl S'WH MEtiAPPEARS ON THE FACE MUST SIGN IN PRESENCE, OF ANRIOTARY;:,PUBLIC I I n i +.IWt ry� ,ill %,,,N, R (l iif �'ilil tr t A I i i i NUJ I r!' SIG SELLER S) PRINT NAME.pF SyL ER(S) G W 4. 'Y COUNTY CLERK OR NOTARY MY COMMISSION EXPIRES' SIGNA,TURE'OF PURCHASER(S) My commission expire i Tn/ c° Y TR/t€ g1 uy rc yr ,7 M SALE. C"'r {J19�+ /t U;Ia Z�,:I:+� Mw w aa d' t, tE es 'rivar y r1 14 00N14-11-0 de-. 111/1417 Y Title No. Issued to AgElicant SELLER(S) NOTARY :STATEMENT SIGNATURE OF PURCHASER(S) ZIP APPEARED BEFORE MEIN THE STATE OF :..THIS DAY OF Q r0 14� EI fi i 201 lE r DONAL IVY, ",r +rU4S PUR.CHASER'S APPLICATION L' information on this application for CERTIFICATE OF TITLE is true and correct ene RH�i r am lawful a for Ws/o i i g e/us and is subject to the bens shown and none other. OWNERS AGF1 E p TITL,E.WILL JOINT OWNERSRIP Y41T1 SI,"RVIVOR'S. IPr l MV -301 (01/10) WYOMING OFFICE OF COUNTY CLERK LINCOLN COUNTY KEMMERER, WY TIFICATE F TITLE k WATERCRAFT CODES TITLE NUMBER FEE 55� p DATE IS CJ'�D 12- 285227 Og 08/21/2013 1C3TQRY PRIG I'ry�!; I%TATiL,p 4 i $1,,238.00 ��44r OWNER WHITNEY, ROBERT 2873, CROOKED WASH DR. LOVELAND CO 80538 PI NO, :,'SELLER 4 Whitne H sell;° 1 FOR COUNTY CLERKS �USE,ONLY: Deputy ODOMETER'; VESSEL LENGTH IN WITNESS WHEREO I have hereunto caused this iCertifi- cate to be signed' and- the dfffcial of this to office 'be nnf placed thereon. •-F of k ?ii eallt-1e ag e-- CClerk CO( v ---t r 1? P,ROPLSN Fit; LOOK FOR Li; li)E 1N;ATI =Fi VEHICLE IDENTIFICATION ENO. HULL IDENTIFICATION NO C200C19F4003023 Second Lien Released .Cg6ny Clerk:. Deputy p..e'P1'Y(IrVI VESSEtTYPE 0 s.:(Date) Not Available/Not Applicable ENGINE b ivE (PURGH. DATE /Irk?. 08/21/2013 L) (SEAL) Released (Date) ILK IN SHEET NOT VALID IF ALTERED OR CHANGED (SEAL) 1- Canoe/Kayak 2 -Open Motorboat 3- Rowboat 4 -Cabin Motorboat 5- Pontoon Boat Vessel Type 6- Houseboat 7- Personal Watercraft (Jet Ski) 8-Sail Boat 9 -Other Hull Material 1- Fiberglass 2- Aluminum 3 -Wood 4 -Steel 5- RubberNinyl /Canvas 6 -Rigid Hull Inflatable 7 -Other Propulsion Type Engine Drive Type 1 -Propeller 2 -Sall 3- Waterjet 4- Ainhrust 5- Manual 1- Outboard 2- Inboard 3- Inboard/Stern Drive 5104568 THIS IS TO,E3E FILLED THE SELLER .A.Np. DELIVERED TO THE PURCHASER AT THE TIME THE VEHICLE IS DELIVERED, PURCHASER MUST MAKE APPLICATION 1111 N vER TItillE1 WIT RE, CLERK. THIS DOCUMENT IS VOID IF ALTERED THIS DOCUMENT MUST BE SIGNED BY ALL SELLERS AND BUYERS 0 NIMENT OF OWNERSI-IIP 4 PPM. 04 3.4 W 1 'Iv 1-,' (X 2 0 7 11 3i4C..koo k S in) w A N PO 1 STREET COLpRA00 8 a 513 8 72. 7 2— CITY 7 4 vv .,TE. iv.",„ ZIP i.iionniiiR)5166 STATEMENT 4„,„4, :r, :'1i.' ;Y:',.0:' 11 lite0 Vet!' l 0,, 4 ...r. FEDERAL ;;AND STATE REGULATIONS REQ you to state!,theloqqage trane grof ownership ehicle. Failur to complete or pro d no a faise statement may restikkliries and/or imprisonment D 41\1 A L. 0 6 W I 11 El( hereby state that the odometer now reads y'lmowledge, it reflects the statement checked belew: C LiNTYZOIL OR NOTA MY COMMISSION EXPIR S) SI 1 at Aniount of Lien Al I, A N§,and Address of Secured Party SIGNAIONE OF PURCHASER(S) SIGNATURE OF PURCHASER(S) Sib'scrib d sworn before me thi At.) (Notary P ulffo erson griz d to Ad ii My My commission expire I 0,12,ENSIA e,REVEN,L, r a YEAR ID 3 Date of i lp g, ti A danibtah 1 0, day of 0 CT e,k4''''K 26 13 A N;;ten.:th,,: the actual mileage of the vehicle, or 17 the amount 'of mileage in excess of mechanical lirnits; or ),...,:es eq,,to best 01/11,,NEFISNVHO W14EAPPEARS ON THE FACE: NIUST SIGN IN THE PRESENCEOF TARYPLIBIG :;',:0;: 1 t f, li I I dom: eadiro sNO3.001,act 1"1 'ARO N. DOM ERf/ISRE I/VVEigoihereby certify and warrant that 1/WE am/are the true and lawful owner(s) of the vehicle described herein and further warrant h ens an ,,,V., Ces Voldi he pi ly liens land encumbrances against the vehicle herein described and hereby transfer and convey an rights; title and interest that IIWE h' the vehi le ,ein'.'ilescriorerflto th' ed indivial(s): and if the vehicle herein 'described is a mobile home, do hereby certify that all taxes due for the preceding and current year he mob ho e have been paid. HI AlIkgek ,IPII"I'II 1411kii. THE rov ,otr,. jJ A, WOW:" SIG 4 E SELLER( A w SALE DATE OF 1-"e% C, 6 gilltER(S)i#9PRY '$1 Dor c• WW rr7verY APPEARED BEFORE ME IN THE STATE OF 3 26.13: DAY OF Avo YEAR PURCI-TASER(S)TRINTED NAME PO AJA L D int 4-1 trivrt 40 AgonymgpmENT OF ODOMETER STA WC:" 4, 1''" r ,PURCHASER'S LL ,nformafuon rin4his applloation fOr"CERTIFICATE OF TITLE true and correct ar; 'us and is aublabt to the liens and none 'atifia'. _YES N 9 0* OWNERS AGREEITHgJ TITLE,WiLL SHOW OWNERSHIP q .101,111...11111.01011/1111.110.1%