HomeMy WebLinkAbout974975IN THE DISTRICT COURT OF THE THIRD JUDICIAL DISTRICT
IN AND FOR THE COUNTY OF UINTA, STATE OF WYOMING
IN THE MATTER OF DETERMINATION OF HEIRSHIP OF
ROBERT B. JOHNSON,
Deceased.
Probate No.
AFFIDAVIT FOR DISTRIBUTION OF ESTATE
974975 1/17/2014 1:25 PM
STATE OF WYOMING LINCOLN COUNTY FEES: $30.00 PAGE 1 OF 7
BOOK: 826 PAGE: 860 AFFIDAVIT
SS. JEANNE WAGNER, LINCOLN COUNTY CLERK
COUNTY OF LINCOLN
a. 2011 GMC; VIN #2CTFLTE57B6415516
b. 2008 Dodge Pickup; VIN #1D7HW48K28S544360
c. WYHY Federal Credit Union Savings Account #....6775
d. Contents /Personal Property in the House
Probate\Johnson \Affidavit of Distribution
11111111 111
two hundred thousand dollars ($200,000.00).
III 111111111111111111V III I I IIII I III 1 11111 IIll I I I III II
We, Nancy Combs, Robert Johnson and Kathryn Johnson, also known as Kathryn Knepper,
being first duly sworn, on oath depose and state as follows:
1. That we are over the age of twenty -one (21) years.
2. That Robert B. Johnson is our father.
3. That our father, Robert B. Johnson was a widower when he died on the 7 day of November,
2013 in the Town of Diamondville, County of Lincoln, State of Wyoming as is shown by the
certified copy of the certificate of death that is identified as Exhibit 1 and attached hereto and
made part of this instrument by this reference.
4. That Robert B. Johnson's spouse pre- deceased him, having died on September 29, 2013.
5. That our father, Robert B. Johnson had a Will upon his death and that he left the remainder
of his estate in equal shares, share and share alike per stirpes, unto my children who are:
Nancy Combs, Liisa Lynch, Robert Johnson and Kathryn Johnson.
6. That our sister, Liisa Lynch predeceased our father. She died on the 25 day of June, 2012
in the City of Kemmerer, County of Lincoln, State of Wyoming as is shown by the certified
copy of the certificate of death that is identified as Exhibit 2 and attached hereto and made
part of this instrument by this reference.
7 That the personal property owned by Robert B. Johnson is as follows:
8. That the value of the entire estate of Robert B. Johnson wherever located, does not exceed
9. That thirty (30) days have elapsed since the date of the death of Robert B. Johnson.
10. We are entitled to the payment or delivery of the property of Robert B. Johnson and there are
no other distributees of the Decedent having a right to succeed to the property under probate
proceedings.
11. That no application for appointment of a personal representative is pending or has been
granted in any jurisdiction regarding Robert B. Johnson.
12. If any other asset or personal property is located that is not identified above, we are entitled
to that property.
Dated this 7 day of January, 2014.
STATE OF WYOMING
COUNTY OF LINCOLN
DEBRA A. HANSEN NOTARY'PU&LIC
COUNTY OF
LINCOLN
MY COMMISSION EXPIRES
STATE OF
WYOMING
0
Probate \Johnson \Affidavit of Distribution
ss.
NANCY CMBS
Page 2 of 4
I, Nancy Combs, being first duly sworn, states that I am one of the affiants noted above in
the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and that
the statements contained therein are true.
1.2 4),,t%
NANCY COMBS
This Affidavit for Distribution of Estate was signed and sworn to before me this 7 Fn day
of January, 2014, by Nancy Combs.
/2.
NOTARY PUBLIC
My Commission Expires: 3by /d0/
Dated this day of
STATE OF WYOMING
COUNTY OF
NOTARY PUBLIC
HOLLY L. MILLER
STATE OF WYOMING
COUNTY OF NATRONA
;%v Commission Ex. roes Dec 14, 2015
Probate \Johnson \Atf davit of Distribution
ss.
tact t
ROBERT JOHNSON
I, Robert Johnson, being first duly sworn, states that I am one of the affiants noted above
in the Affidavit for Distribution of Estate, that I have read the same, know the contents thereof, and
that the statements contained therein are true.
ROBERT JOHNSON
is Affidavit for Distribution of Estate was signed and sworn to before me this I' day
r
atom 2014, by Robert Johnson.
NO ARY P
My Commissi b Expires:
[The remainder of this page is intentionally blank.]
Page 3 of 4
Dated this 11 day of (/fl awry 2014.
STATE OF WYOMING
COUNTY OF 4a�G J~
Probate \Johnson \Affidavit of Distribution
ss.
KATHRYN JOHNSON, a/k/a
KATHRYN KNEPPER
I, Kathryn Johnson, also known as Kathryn Knepper, being first duly sworn, states that
I am one of the affiants noted above in the Affidavit for Distribution of Estate, that I have read the
same, know the contents thereof, and that the statements contained therein are true.
KATHR JOHNSON, a/k /a
KATHRYN KNEPPER
his Affidavit for Distribution of Estate was signed and sworn to before me this day
of clan t:PGi' t 2014, by Kathryn Johnson, also known as Kathryn Knepper.
NOTARY PUBLIC
My Commission Expires:.-
Page 4 of 4
Celeste Terpening Notary Public
County of State of
Laramie t�S'D::!? Wyoming
M y Commission Expires a 1
CERTIFICATIO ITAL RECORD
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent Infor
Place of Birth:
Residence:
Marital Status:
Forces:
Name of Father:
Name of Mother:
Yes
Herman Johnson
Use Sophia Lassila
Informant: Nancy Combs
Robert B. Johnson
Mate
October 29, 1927
November 07, 2013
Diamondville
17 Burgoon Drive
mation:
Diamondville, Wyoming
Diamondville, Wyoming
Widowed
Disposition:
Method of, Disposition: Cremation
Place of Disposition: UFD Cremation Center, South Jordan, Utah
Ball Family Chapel, Evanston, Wyoming
Funeral Home or Facility:
Facility:
Cause: of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) Metastatic Lung Cancer
(b) Chronic Tobacco Use
Other Significant
Conditions:
Manner of Death: Natural Death
Certifier:}
Type:
Name:
Address:
Date Filed: r`
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Physician
Chad Seiler, M.D.
PO Box 390, Kemmerer, Wyoming, 83101
November 20, 2013
73,4733
This isra•true certification of the document on file in the office of Vital
Statistics Services,, Cheyenne, Wyoming,
DATE ISSUED:
Thursday, Novembe 21, 2013
This is not valid unless prepared on paper with an engraved border.
Social Security Number:
Age at the Time of Death:
Time of Death:
86 years
u omp+u
James McBride
Deputy State Registrar
1�
1
bl,. 730669
STATE OF WYOMING
This is a true certification of the document on file in the office of Vital
Statistics Services,.. Cheyenne, Wyoming.:
DATE ISSUED: Tuesday, October 22, 2013
This copy is not valid unless prepared on paper with an engraved border.
k L:f f �rff.�.l
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Social Security Number:
amen
James McBride
Deputy State Registrar
y it
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of. Death:
Date of Death:
City of Death:
Location:
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
Additional Decedent Information:
Natural Death
i
Helen Margaret J ohnson
Female
April 13, 1931
September 29, 2013
Diamondville
17 BurgoonDrive
Windsor, Ontario, Canada
Diamondville, Wyoming
Married Robert B. Johnson
No
Edwin Sohlman
Lyyli Junnila:
Robert B. Johnson
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Facility:
Cause of Death
The immediate cause is listed, on the first line followed by an
(a) CVA
Cremation
UFD‘Cremation Center, South Jordan, Utah
Ball Family Chapel, Evanston, Wyoming
(b) HYPERTENSION
Hyponatremia, CAD, ANEMIA
Physician
Jeremy Starr, M.D.
P0 Box 390, Kemmerer, Wyoming, 83101
October 21, 2013
Age at the Time of Death:
Relationship:
i underlying causes.
Time of Death:
2013- 003194
Husband
Interval:
Approximate '07:00 ±3hrs
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Social Security Number:
James McBride
Deputy State Registrar
Fa
Decedent:
Name:
Gender:
Date of Birth:,
bate and Place of Death:
Date of Death: June 25, 2012
CERTIFICATION
Liisa Aileen Lyn ch
Female
July 22, 1956
City of Death: Kemmerer
Location: South Lincoln Medical Center PO Box 390
Additional Decedent Information:
(b) MRSA septic shock
(c) Cellulitis of face's
Certifier:
Type:
Name:
Address:
Date Filed:
Other Significant
Conditions:
Manner of Death: Natural Death
641149
Evanston, Wyoming
Kemmerer, Wyoming
Married Kenneth Lynch
No
Robert B. Johnson
Helen Margaret Sohiman
Robert B. Johnson
Place of Birth:
Residence:
Marital Status:
Armed Forces)
Name df Father:''
Name of Mother:
Informant:
Disposition:
Method`of Disposition: Burial
late of Disposition: Diamondville Cemetery, Diamondville, Wyoming
Funeral Home or Facility:
Facility:
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) Respiratory arrest
Ball Family Chapel, Evanston, Wyoming
end stage COPD, Hypoxemia
Physician
Jeremy Starr, M.D.
PO Box 390, Kemmerer, Wyoming 83101
July 11, 2012
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUEDTuesday, July 17 2012
This copy is not: valid unless prepared oepaper with an engraved border
Age at the Time of Death: 55 years
County of Death:
Relationship:
2012 001986
Lincoln
Father
Time of Death/"
20 :35 (Actual)