HomeMy WebLinkAbout974796WYOMING AFFIDAVIT OF COLLECTION OF ESTATE ASSETS
RELEASE OF ACCOUNT OR PERSONAL PROPERTY WITHOUT COURT ADMINISTRATION
To Comply with WYOMING STATE STATUTES SECTION 2 -1 -201 ET SEQ
I /We Jeff Braegger and Donna Poulos (Affiants and distributees) individually and jointly the
undersigned first being duly sworn upon oath state:
1. Max Braegger (the decedent) died while resident of the City of Kemmerer, County of Lincoln, State
of Wyoming on January 6, 2013.
2. At least thirty (30) days have elapsed since the death of the decedent.
RECEIVED 1/2/2014 at 8:58 AM
RECEIVING 974796
BOOK: 826 PAGE: 278
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0278
3. No application for appointment of a personal representative is pending or has been granted in any
jurisdiction.
4. The current value of the decedent's entire estate, wherever located, less liens and encumbrances,
does not exceed two hundred thousand dollars ($200,000).
5. The claiming distributees are entitled to payment or delivery of the property by virtue of the fact the
distributees are Children of the decedent:
6. At the time of the death of the decedent, the decedent was the owner of certain personal property
described as follows:
(a) Vehicles:
1977 Ford Truck, VIN# F14HRY88348, Title# 12 125060, Issued 7/22/1986
1999 Ford Truck, VIN# 1FTRX18LXXKC19926, Title# 12- 0194006, Issued 12/20/1999
(b) The decedent's guns and personal property in possession of Lincoln County Sheriff.
(c) The decedent's interest in any other personal property in possession of others.
7. The affiant(s) are entitled to payment or delivery of the described property, are sole distributees and
children of the decedent and requests that the described property be paid, delivered or transferred to
affiant(s) directed as follows:
(1) The decedent's property in possession of Lincoln County Sheriff Department to be delivered to
Jeff Braegger.
(2) The Titles of the following vehicles to be transferred to Jeff Braegger.
1977 Ford Truck, VIN# F14HRY88348, Title# 12 125060, Issued 7/22/1986
1999 Ford Truck, VIN# 1FTRX18LXXKC19926, Title# 12- 0194006, Issued 12/20/1999
8. Affiants are the successor to the decedent's interest in the described property and no other person
has a superior right to the interest of the decedent in the described property under probate
proceedings.
9. If there is more than one affiant, all statements in this Affidavit are made individually and jointly.
10. In consideration of any person or entity honoring this Affidavit, Affiant(s) agree(s) that said person or
entity cannot be held liable for giving Affiant(s) the personal property described in paragraph 6 and
agree(s) to indemnify person or entity and hold person or entity harmless against all liability, loss, costs,
damages or expenses, including attorney fees, which person or entity may incur by reason of its
honoring this Affidavit.
11. Each Affiant affirms or declares under penalty of perjury under the laws of the State of Wyoming
that the foregoing is true and correct.
This Affidavit is executed on this :__SL day of c�� .c'!'f T 20 in the City of
SIGNATURES OF AFFIANTS
State of io 00
Jeff Braeg
331 I St. Apt. B
Rock Springs, WY 82901
Donna Poulos
1041 Ponderosa way Apt. D
Rock Springs, WY 82901
0279
STATE OF WYOMING
)ss
COUNTY OF
On this SO day of 1::)�cN,1 i,3
Jeff Braegger and Donna Poulos.
Known to me to be the individual(s) who executed the foregoing affidavit and, being duly sworn, did
depose and say that the statements contained therein are true.
Notary Public
My commission expires: 0 03)) (e
before me personally appeared
DEBRA HAWKINS
Notary Public
Sweetwater County, o ing
My Commission Expires 0
0280
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CERTIFICATION
OF VITAL RECORD
4
DECEDENT
Date of Death: January 6, 2013
City of Death: Salt Lake City
75
1 Birth: Ogden, UTan
Arrne
No
Musty/Bus
Residence: Kemm r
H n° we
CERTIFICATE OF DEATH
State File Number: 2013000195
Max Braegger
Time of Death:
County of Death:
Date_ of Birth
MaritalfStbtus:_
UsualtacUpatidn:
Lincoln County-Sheriff Office Educatioit
erer, VVyoming Father's Name: Carl Arthur Braegger
I Hanskey
Facility Type: Hospital Inpatient
Date of Dripaiti
Motner s Name.
F cr,Addr_e_ss:_ Universittlp_fUtah 1
t e. aridersdale Rd. CambY Indiana 4611
,e.(s-ri:- Kemmerer Wyoming
N
UPerall
Plineral Horne
=MEDIAL
John MD, N. Medical Dr., Salt Citle(Salt Lak
Robert Braegger Rela116 Brother
367 E
DiaposiTION INFORMATION
Method Of DisLo„si Remoyal
JIace ispt So
Address' bx„6, 105 East Center Street Kama's Utah
Funeral Director: W Bali
02:00
Salt Lake
December 26- 1937
"Male-
Widowed Sheriff
Cardiopulmonary arrest
Cardiopulmonary
,E)ue (oras a consetftlence of): ';ivietastatic, cancer,
Tobacco'llse Unknown'
ie E taCted: N Y.Performed: No Manner of t I
Dat6' Registered: Janu 10
Date Issued:,JanuarY 10, 2013:A
-PPIFIF`
Some College but No Degree
-_---.7his is arrexaclieproduction of the:document registered the State Office c•tVitiE-Statisticc-
images in top cyCloida z€_
titurity features of this officiai docunrient inciude: Itctaglio.Barder,Atlt R
%I cer. n ultra:Violet fibers and hologram imageiof the _Utah State Sealrover the words "State offitahn. This====.-
;.•000...... 'N document displays the date, seal and signatureTof State Registrar and the County/District Health Offi --7 .t-`""
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