HomeMy WebLinkAbout975408STATE OF WYOMING
SS.
COUNTY OF LINCOLN
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF TERRI THURMAN
11 1111
II
975408 2/24/2014 11:02 AM
LINCOLN COUNTY FEES: $24.00 PAGE 1 OF 5
BOOK: 828 PAGE: 422 AFFIDAVIT
JEANNE WAGNER LINCOLN COUNTY CLERK
COMES NOW GARY CLINTON HAGGER, after being sworn and under oath,
hereby stating pursuant to Wyoming Statutes 2 -1 -201, which authorizes Affidavits of
Distribution, as follows:
1. That Stewart H. Thurman, a Grover, Wyoming died on August 19, 2007. An
official copy of the Certificate of Death issued by the State of Idaho is attached hereto.
2. That Stewart H. Thurman owned a vehicle, a 1998 Jeep, VIN No.
1J4GZ58S9WC231469, a as joint tenant, with right of survivorship with Terri Thurman.
3. That as a result of the death of Stewart H. Thurman, Terri Thurman became the
sole owner of the above referenced vehicle.
4. That Terri Thurman, a resident of Grover, Wyoming, died on January 10, 2014.
An official copy of the Certificate of Death issued by the State of Wyoming for Terri Thurman is
attached hereto.
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF TERRI THURMAN
PAGE 1 OF 3
October 10, 2013, is attached hereto.
6. That the Last Will and Testament provides that the beneficiary of her estate is the
Successor Trustee of The Terrilynn Thurman Family Living Trust dated January 10, 2008,
restated as amended October 10, 2013.
hereby state:
5. That Terri Thurman died testate. A copy of her Last Will and Testament, dated
7. That I am the Successor Trustee of the above referenced Trust.
8. That, in accordance with the requirements of Wyoming Statutes 2- 1- 201(a), I
a. That the value of the entire estate Terri Thurman, 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 Terri Thurman.
c. That no application for appointment of a Personal Representative is
pending or has been granted in any jurisdiction in Wyoming.
d. That pursuant to the above referenced Trust, I, as the Successor Trustee,
am entitled to title to the above referenced vehicle. There are no other persons or entities
having a right to these assets under probate proceedings.
4. That I hereby request that title to the above referenced vehicles be titled in the
name of "Gary Hagger, Trustee with the address of record being: "4105 Greenwillow Lane,
Idaho Falls, Idaho 83401
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF TERRI THURMAN
PAGE 2 OF 3
DATED this 21st day of February, 2014.
ON THIS, the 21st day of February, 2014, GARY CLINTON HAGGER, 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 ei State of
Lincoln Wyoming
My Commission Expires: July 16, 2015
My Commission expires: 0 9 //6 /if
AFFIDAVIT OF DISTRIBUTION
PURSUANT TO WYOMING STATUTES 2 -1 -201
FOR
THE ESTATE OF TERRI THURMAN
PAGE 3 OF 3
GARY LINTON HA R
DECEDENT
TYPE OR
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ENT
BLACK INN
CO NOT USE
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IN9TRUCT10NC
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PARENTS
...JNEOBMANT„-;
CERTIFIER: Complete Within 72 Hours of Death I MORTICIAN: CompleteNerity and File Within 5 Days of Death
1. DECEDENTS LEGAL NAME (Include AKA's II any) (Full. Middle. Last, Su x)
Stewart Humphreys Thurman
2. SEX
Male
3. SOCIAL SECURITY NUMBER
1 11
4s, AGE -Leal Birthday
69 (Years)
4b. UNDER 1 YEAR
4c. UNDER 1 DAY
Hours MMUle6
y Mo /Da /Yr
5. DATE OF BIRTH
January 30, 1938
6. BIRTHPLACE
Afton,
(City. and Sale. Territo ry, or Foreign Country)
Wyoming
TOWN
Falls
Months Days
7a. RESIDENCE STATE OR FOREIGN COUNTRY
Idaho
7b. COUNTY
Bonneville
7c. CITY OR
Idaho
7d. STREET AND NUMBER
1485 Juniper Driver
7e. APT, 240. 71. ZIP CODE 17g. INSIDE CITY
LIMITS?
83404 J r ues [i No
0, MARITAL STATUS AT TIME OF DEATH
R Married 0.M,Med,bulseparated U Widowed 0 Divorced 0 Never married ❑Unknown
9. SURVIVING SPOUSE'S
Terri Lyn
NAME (11 wile, give maiden name)
Clem
10. EVER IN U.S.
ARMED
FORCES?
Yes
0 No
11a. FATHER'S NAME (First, Middle, Last, Suffix)
Stewart McCombs Thurman
11b. BIRTHPLACE. (Slate. Territory, or Foreign Country)
Wyoming
12s. MOTHER'S MAIDEN NAME (First. Middle. Last. Suffix)
Adell Humphreys
12b. BIRTHPLACE (Stale. Territory, or Foreign Country)
Wyoming
13e. INFORMANTS NAME (Type or prinl)
Terri Lyn Thurman
113b. RELATIONSHIP TO DECEDENT
I Spouse
13c. MAILING ADDRESS (Street and Number, City, State, Zip Code)
467 1st Street
I Grover, Wyoming 83122
14, METHOD OF DISPOSITION
6a Bunel 0cremagon
❑Donation OEntombment
fRi Removal from ldaho
0 Other city
15. PLACE OF DISPOSIT)ON (Name and address of cemetery,
crematory, other place)
Grover Cemetery
Grover, Wyoming
16. NAME AND COMPLETE ADDRESS OF FUNERAL FACILITY
Schwab Mortuary
44 East 4th Avenue
Afton, Wyoming 83110
DISPOSITION
PLACE OF
DEATH
DATE OF
DEATH
CAUSE OF
DEATH
ITEMS 32 -30
TO BE USED
FOR EXTERNAL
,..CAUSES Ofd
ICOHON[.lil
i e a
„AF DEATH WAS
i ;DUE TN NATURAL
.,,THAN NATURAL
CAUSE6,
THE CORONER
MUST
COMPLETE ANp
SION
91TI FICATE THE
CERTIFICATE
17e..S NATU OF FUNERAL SER E LICEN R PERSON ACTIN S SUCH
174. LICENSE NUMBER (0) licensee)
M 676
16. WAS CORONER CONTACTED
DUE TO CAUSE OF DEATH?
0 yea a No
t,t C(
1
PLACE OF DEATH (19 22
RED IN A HOSPITAL:',* 19b, IF DEATH OCCURRED SOMEWHERE OTHER THAN 4 HOSPITAL:
d
/9a. IF DEATH OCCU_
.O lnpalIenl 20 ER/Oulpatienl 30 DOA Hospice facility 30 Nursing home/Long term care facility q Decedent's home f] Other (Specify)
20. FACILITY NAME (11 no facility. give shoe) and number)
1485 Juniper Drive
21. CITY, TOWN, OR LOCATION OF DEATH, AND ZIP CODE
Idaho Falls 83404
22. COUNTY OF DEATH
Bonneville
26. TIME p9ONOUY ED DEAD
08 30 (24hr)
23. DATE OF DEATH (Mo/Oay/Vr) (Spell month)
August 19, 2007
24. TIME OF DEATH
0830 Roo
25. DATE PRONOUNCED DEAD (Mo/Day/Vr) (Spell month)
August 19, 2007
27. CAUSE OF DEATH
PART I. Enter the chain DI evens diseases, injuries, or complications -than directly caused the death. DO NOT enler terminal evens such as cardiac Approximate Interval:
arrest, respiratory ones/; or ventricular fibrillationwilhoul showing the etiology. 00 NOT ABBREVIATE. Enter only one cause on a line: Onset to Death
IMMEDIATE CAUSE (Final c,r L0M`I -7, v.i 4/
a.
'disease or condhbn J
resulting In death) DUE TO ter as a consequence o0:
Sequentially list condhions, b.
if any, leading to the cause CUE TO (or as a wnsemuence oil:
listed on line e. Enter the
UNDERLYING CAUSE
LAST (disease or Injury OUE TO far as a consomme ol)1
that lnlllated the events
In death) d.
resulting
PART II. Enter other slmilicant conditions conlribulino to death but not resulting in the underlying cause given in Pan I
28a. WAS AUTOPSY 286. WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE TO
THE CAUSE OF DEATH
07es XNo 7 Yes El NO:'`,
29. DID TOBACCO USE
CONTRIBUTE TO DEATH?
0 Yes Probably
I o I_I Unknown
30. IF FEMALE (Aged 10 -54):
0 Not pregnant within pas) year 0 Nol pregnanl, but pregnant 43 days
0 Pregnant al lima of tlealh to 1 year before tlea)h
0 Nol pregnanl, but pregnanl 0 Unknown it pregnanl within the past
within 42 days or death year
31. MANNER OF DEATH
I�iNalural 0 Homicide.
0 Accident 0 Pending Investigation
0 Suicide 0 Could not be determined
32 DATE OF INJURY (Mo/Day/Yr)
(S ell month)
33. TIME of INJURY
(24hr)
34. PLACE OF INJURY (Decedent's home, farm, street. construclion site,
nursing home, restaurant. forest etc.)
35. INJURY AT WORK?
1
Yes No
36.'LOCATION OF INJURY: 51.10 1)7(0040 or count' Zip Code
Sueel Number ticn Apartmeril Number
and 0,1,00
37. DESCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY, STATE THE TYPE(S) OF VEHICLE(S) INVOLVED (Automobile, pickup. motorcycle, ATV, bicycle, etc.)
SPECIFY WHICH VEHICLE DECEDENT OCCUPIED, if applicable
TRANSPORTATION 1313a. WAS DECEDENT: L I Driver/Operator 0 Passenger 38b, WHAT SAFETY DEVICE(S) DID DECEDENT USE/EMPLOY?
INJURY ONLY 0 Pedestrian 0 Other (Specify) 0 Seal Bell 0 Child safely seal 0 Hahne/ 0 Air bag i None Unknown
390, CERTIFIER (Check only one, based on official capacity for Ills certificate)
1 PHYSICIAN 0 PHYSICIAN ASSISTANT 0 ADVANCED PRACTICE PROFESSIONAL NURSE
o Ine:besl of 01 knowledge. death occurred al the lime, date. and place. and due to the natural causes) /manner staled.
T Y edg
0 CORONER
the heals of exeminalbn and/or investlgElryl I op in my death occurred al the lime, date, and place, and due to the cause(s)
an and.menner staled 1
11
Si an d Title of Certifier If 1'._/
39b. LICENSE NUMBER
C."
1... 1
39c. DATE SIGNED
C- Z{°
i' T
MM DD YVVV
A
39d. NAME, ADDRESS, AND ZIP CODE 1:(C pr FIER (Type or wing
Christian •T. Shull, M.D.;'2.330 DeSoto St.; Idaho Falls, Idaho 83404
40a. CORONER'S SUBSEQUENT SIGNATURE IF NECESSARY:' The coroner's stgnalure to this item, supersedes that or the physician,
physician assistant, o, advanced practice professional nurse, and the coroner becomes the certifier of retard.
40b. DATE SIGNED
I have reviewed and 11 necessary amended !he medical seclton
MM DG' VYYV
REGISTRAR
Ala, REGISTRAR'S SIGNATUR 1 414. DATE SIGNED
/2Z ?1
41 .tt e -1611 r 16 44 e-
CERTIFICATION OF VITAL RECORD
IC L RECORD
3.1.1.1. f.....- .1.333. 3,1,3.3;;;f43.)3!:::.!: ff.; 33 .1.3 .1.1..
Itl.\lt"
0
000881
DATE FILED BY STATE REGISTRAR:
1111.711 1 I Al flap
STATE OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
State of Idaho
CERTIFICATE OF DEATH STATE FILE NO.
W A CCP0 naS DOCUMENT. THE REGISTRAR w n DEPARTMENT 4
m, F DEPARTMENT OF HEALTH aNDW Vaa[ Local Reg. NO.
OF
FaL SNMI M USED AS MAN. FACIE EVIDENCE OF /US DEAni UNDER 13.24,1411 AND FDB274.I0ANO CODE
This is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS.
DATE ISSUED:
This copy not valid unless pr -pared on engraved border
displaying state seal and signature of the Registrar.
C'003 76
JANE S. SMITH
STATE REGISTRAR
IIf..
CERTIFICATIO TAL RECORD
DataFlle
MOTHER •MAIDEN NAME
BETTY:
METHDD aa:plP.'Osivoi
R f
DATE' OF INJURY
WAWA
EATHERC:'NAME' C3!: 2i:S''
WILLIAM COLUMBUS''
:(underlying Sauce last)
DUE TO {ones a consequence of):
Dt7E YC):(or ee;a`con gin de' of):
pgseRFTION OF HOW INJURY OCCURRED::
cR LUNi:: P.N:EU:MONIA
DATE ISSUED:
1=,UHER 'SERVIE :t:IQENSEE
RAI
NAME ANbADDRESS OFPUNERAL'FA6ILITY' L'.
..NALDE;R FUNERAL HOME, SHELLEY, IDAHO
IDAHO DEPARTM .ENT :OF NEALTM ANOVELEARE
BUREAU OF VITAL'I ECORIS AND a-1EAl TN STATISTIC$?
TIME OF INJURY.:,
1 I F I I)A H O
NAME OF SURVIVING SPOUSE (II ails, maiden name):
UARY '.Y'6`•: "2014
Thig. not valid unless prepared on engraved border
thspalingtate seal and signature of the Registrar.
rnNCUps)O0l2
F .DEATH
PLACEDF:RESIDENCE
GRO.VE WYDM;NG
CITY,TOWN OR LOCATION OF DEATH
I DAHO FALLS, IDAHO
MANNEROR :UEATH °L: NAME;OFCERfrFIER
NA TUR AL BREN.T :W MUEL.LER M. D.,'
CORONER SUBSEQUENT CERTIFICATION: IF NECESSARY::`;`
I This is a true and.cprrect. reproduction of the document officially registered and pladed
on file witt2:•Yhe IQAHO B:U:REAU OE::V.ITAL :RECORDS AND HEALTH STATISTICS.
PLACE OF INJURY'
:BIRTHPLACE
DA