Loading...
HomeMy WebLinkAbout975848BANK-f EWEST ...r NOTICE TO BANK: MUST BE FILED WITH COUNTY CLERK AND ANK MUST RECEIVE A CERTIFIED COPY PRIOR TO ANY DISTRIBUTION OF ASSET I/We [Enter name(s)] Ch 7 and jointly "Affiant whose address(es) is /are: (Attach additional sheets as needed) declare to Bank of the West "Bank that the following is true and correct: 1. (Name of Deceased) `t./. itel -a-, 7 A 1: /7) /37x'/ C. County of /ii') /0/1 State of ye,) on (Date) j ////r" /V 2. At least thirty (30) days have elapsed since the death of the decedent, as shown in a certified copy of the decedent's death certificate attached to this affidavit. 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 distributee(s) are entitled to payment or delivery of the property by virtue of the following facts concernin the distributee's relationship to the decedent: Distributee(s) are: [Check appropriate box(es Parent(s); Spouse; Child(ren); Grandchild(ren); Sibling(s); Child(ren) of Sibling(s); Aunt(s)/Uncle(s); Heir(s) under will; Heir s) at law; Trustee of trust taking under a pour -over will; Other Describe: There are no other distributees of the decedent having a right to succeed to the property under probate proceedings. 6. At the time of the death of the decedent, the decedent was the owner of certain personal property held by Bank of the West, which personal property is described as follows: (a) Funds on deposit in the aggregate sum of Dollars in the following accounts: (b) (c) Page 1 of 2 AFFIDAVIT UNDER PENALTY OF PERJURY FOR RELEASE OF ACCOUNT OR PERSONAL PROPERTY WITHOUT COURT ADMINISTRATION WYOMING STATUES SECTION 2 -1 -201 ET SEQ. (FOR ESTATES WITH A TOTAL VALUE OF $200,000 OR LESS) Branch Name City /State Account No. Amount (JP 5 i /PU C.- /41�G?4'1///r•, ?/5 4/4) Personal property situated in safe deposit box or vault no. or held in safekeeping at this branch; (Enter Branch Name and State) The decedent's interest in: (Describe) 975848 4/8/2014 2:21 PM LINCOLN COUNTY FEES: $24.00 PAGE 1 OF 5 BOOK: 830 PAGE: 241 AFFIDAVIT JEANNE WAGNER LINCOLN COUNTY CLERK 11111111111111111111111111111111111111111111111 1111111111111111 u �I! 11 (individually (the "decedent died in the City of 030 -05180 (Rev. 07/11) Name and Address Relationship to Decedent Proportion Due Each Distributee 1) 4,1 1 4.1 1,., NI'` 15 f C) 2 4 ?2/7)t A.)/ v' )c3 1 7 1 e /ci A 1 /50k f`l� 3) _;fie_,. 7.;',--P5-,-... 6eft,t,,4ize g i /Xo/ 51— 4) 7. The affiant is entitled to payment or delivery of the described property, has the relationship described below and requests that the described property be paid, delivered or transferred to affiant(s) directed as follows: 8. Affiant is the successor to the decedent's interest in the described property or is authorized to act on behalf of the successor of the decedent with respect 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. 9. If there is more than one affiant, all statements in this Affidavit are made individually and jointly. 10. In consideration for Bank's honoring this Affidavit, Affiant(s) agree(s) that Bank cannot be held liable for giving Affiant(s) the money and /or property described in paragraph 6 and agree(s) to indemnify Bank and hold Bank harmless against all liability, loss, costs, damages or expenses, including attorneys fees, which Bank may incur by reason of its honoring this Affidavit. A receipt for the payment by each of the distributees shall constitute a valid and sufficient release and discharge of Bank of the payment made. 11. Affiant represents and warrants that Affiant has been advised to consult with legal counsel prior to executing this Affidavit and that Affiant has had the opportunity to consult with legal counsel and has obtained such legal guidance as Affiant has deemed appropriate prior to executing this Affidavit. 12. 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 ji','1� -441? v I 20 i `t in the City of At) Pi Me_ L Nit Il o t t °b '1 MUST BE EXECU D BY ALL DISTRIBUTEES. STATE OF L/ co4 COUNTY OF Loil fre i 1 On c c---, appeared G. (C' i1� personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the saw %ivi (lxipI ipr /their authorized capacity(ies), and by his /her /their signature(s) on the instrument the person(s), or the entity upon behalf elvh h Iheepte kori(s) acted, executed the instrument. WITNESS my h nd and official eal. Se u1 i ;t�co; C ?I `Z i.--12, AcS��4o 030 -05180 (Rev. 07/11) P1 Off' Affidavit Small Estate yoming Page 2 of 2 r w Signature Signature Signature 20 L( before me, the undersigned, a Notary Public in and for said State, personally Signature 7. The affiant is entitled to payment or delivery of the described property, has the relationship described below and requests that the described property be paid, delivered or transferred to affiant(s) directed as follows: 8. Affiant is the successor to the decedent's interest in the described property or is authorized to act on behalf of the successor of the decedent with respect 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. 9. If there is more than one affiant, all statements in this Affidavit are made individually and jointly. 10. In consideration for Bank's honoring this Affidavit, Affiant(s) agree(s) that Bank cannot be held liable for giving Affiant(s) the money and /or property described in paragraph 6 and agree(s) to indemnify Bank and hold Bank harmless against all liability, loss, costs, damages or expenses, including attorneys fees, which Bank may incur by reason of its honoring this Affidavit. A receipt for the payment by each of the distributees shall constitute a valid and sufficient release and discharge of Bank of the payment made. 11. Affiant represents and warrants that Affiant has been advised to consult with legal counsel prior to executing this Affidavit and that Affiant has had the opportunity to consult with legal counsel and has obtained such legal guidance as Affiant has deemed appropriate prior to executing this Affidavit. Each affiant affirms or declares under penalty of perjury under the laws of the State of Wyoming that the foregoing is true and correct. i ti This Affidavit is executed on 1(1. e 2 20 in the City of 0,7_04'' CUttp? Page 2 of 2 State of (L 1: C�h i,l.,l ]G v 1 MUST BE EXEC TED BY 11 DISTRIBUTEES. r S` ignature STATE OF C /L 1C COUNTY OF L L.r/l.C, -i On 11 CEA 0 7 f appeared //ii I// IYI WITNESS my Signature: L Affidavit Small Estate/Wyoming Signature Signature 1 )1 personally known to me (or proved to me on the basis of satisfactory evidence) to ilp gson(s) whose name(s)is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the e Ep veifkk,eir authorized capacity(ies), and by his /her /their signature(s) on the instrument the person(s), or the entity upon behal$bf hs p on('i) acted, executed the instrument. and an off icia eal. 20 L before me, the undersigned, a Notary Public in and for said State, personally Signature 030 -05180 (Rev. 07/11) Name and Address R elationship to Decedent Proportion Due Each Distributee i79/7-I SL),/ 1316/ 2) ya e..e_ CA e d- r't�� 7/4 c( S L7 :;,?7( •7/1c 6 A .)4104 1 /5v g 3 :/c 2 ,c-e5,- R 3�r�� b atAfi pze r 4) 7. The affiant is entitled to payment or delivery of the described property, has the relationship described below and requests that the described property be paid, delivered or transferred to affiant(s) directed as follows: 8. Affiant is the successor to the decedent's interest in the described property or is authorized to act on behalf of the successor of the decedent with respect 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. 9. If there is more than one affiant, all statements in this Affidavit are made individually and jointly. 10. In consideration for Bank's honoring this Affidavit, Affiant(s) agree(s) that Bank cannot be held liable for giving Affiant(s) the money and /or property described in paragraph 6 and agree(s) to indemnify Bank and hold Bank harmless against all liability, loss, costs, damages or expenses, including attorneys fees, which Bank may incur by reason of its honoring this Affidavit. A receipt for the payment by each of the distributees shall constitute a valid and sufficient release and discharge of Bank of the payment made. 11. Affiant represents and warrants that Affiant has been advised to consult with legal counsel prior to executing this Affidavit and that Affiant has had the opportunity to consult with legal counsel and has obtained such legal guidance as Affiant has deemed appropriate prior to executing this Affidavit. Each affiant affirms or declares under penalty of perjury under the laws of the State of Wyoming that the foregoing is true and correct. i ti This Affidavit is executed on 1(1. e 2 20 in the City of 0,7_04'' CUttp? Page 2 of 2 State of (L 1: C�h i,l.,l ]G v 1 MUST BE EXEC TED BY 11 DISTRIBUTEES. r S` ignature STATE OF C /L 1C COUNTY OF L L.r/l.C, -i On 11 CEA 0 7 f appeared //ii I// IYI WITNESS my Signature: L Affidavit Small Estate/Wyoming Signature Signature 1 )1 personally known to me (or proved to me on the basis of satisfactory evidence) to ilp gson(s) whose name(s)is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the e Ep veifkk,eir authorized capacity(ies), and by his /her /their signature(s) on the instrument the person(s), or the entity upon behal$bf hs p on('i) acted, executed the instrument. and an off icia eal. 20 L before me, the undersigned, a Notary Public in and for said State, personally Signature 030 -05180 (Rev. 07/11) Name and Address Relationship to Decedent Proportion Due Each Distributee 1) 0 //'cr /7'1 1)G' ,I,5T^ /5>` 0 A- 67 22 `sh 1310/ 2 V n z- C,/ c1.r1-e S 6 4, 7/41 rti c /for L) Vh! I t 0/1 C' /ofA 1 /Sou S)l is/. k4 .TP5e''` �t.� 3o-A 6 r r "tux,/ ,sue b, M.a '3i/6 ?IJra 4) 7. The affiant is entitled to payment or delivery of the described property, has the relationship described below and requests that the described property be paid, delivered or transferred to affiant(s) directed as follows: 8. Affiant is the successor to the decedent's interest in the described property or is authorized to act on behalf of the successor of the decedent with respect 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. 9. If there is more than one affiant, all statements in this Affidavit are made individually and jointly. 10. In consideration for Bank's honoring this Affidavit, Affiant(s) agree(s) that Bank cannot be held liable for giving Affiant(s) the money and /or property described in paragraph 6 and agree(s) to indemnify Bank and hold Bank harmless against all liability, loss, costs, damages or expenses, including attorneys fees, which Bank may incur by reason of its honoring this Affidavit. A receipt for the payment by each of the distributees shall constitute a valid and sufficient release and discharge of Bank of the payment made. 11. Affiant represents and warrants that Affiant has been advised to consult with legal counsel prior to executing this Affidavit and that Affiant has had the opportunity to consult with legal counsel and has obtained such legal guidance as Affiant has deemed appropriate prior to executing this Affidavit. 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 9 20 4, in the City of 6 4•)v4 AC 11 �h State of /vC� <tirf a MUST B EXECUTED BY ALL DISTRIBUTEES. Gv,., Affidavit S Page 2 of Signature Signature STATE OF GOICfado COUNTY OF kcC.L On Aci, r C L f Signature Signature Q/� 20 before me, the undersigned, a Notary Public in and for said State, personally appeared 1 aI2 _c r' I-� personally lcnown to me 6r proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his/her /their authorized capacity(ies), and by his /her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my nd and .fficial seal. Signature: Wyoming JOSHUA W HIGGS (Seal) Notary Public State of Colorado Notary ID 20134043599 M Commission Ex ires Jul 25, 2017 030-05180 (Rev. 07/11) STATE OF WYOMING 75.65.74. This is a true certification of the document on file in the office of Vital Statistics. Services,: Cheyenne, Wyoming. G DATE ISSUED: Friday, March 14, 2014 This copy ,is notvalid.uniess prepared on withyan engraved border. DEPARTMENT OF HEALTH CERTIFICATE OF DEATH .James McBride Deputy State Registrar A Decedent: Name: William Lee. Popp Gender: Male Date of Birth: July 03, 1945 Date and Place of Death: Date of Death: March 01, 2014 City of Death: Kemmerer Location: Foothill Hwy. 189 310:Sp #3 Additional Decedent Information: Place of Birth: Lanard, Kansas Residence: Kemmerer, Wyoming Marital Status: Divorced Armed Forces: Yes Name of Father: Henry Popp Name of Mother: Rosa Mae Reifschneider Informant: William Lee Pppp, Jr. pisposition Method of Disposition: Donation Place of Disposition: n44 ctn:e yw 1. ff� 1� is 0.11M r `ac l 1 t1 CERTIFICATION OF VITAL RECORD; University of Utah Organ Donation, Salt Lake City, Utah Funeral Home or Facility: Facility: Ball Family Chapel, Evanston, Wyoming Cause: of Death: The immediate cause is listed: On the first line followed by any underlying causes. /(a) Lung Cancer (b) Smoking (Tobacco Abuse) Other Significant COPD Conditions: Manner of Death: Certifier: Type: Name: Address: Date Filed: Natural Death Physician George Krell, M.D. PO Box 390, Kemmerer. Wyoming, 83.101. March 13, 2014< State File Number: Social Security Number: Age at the Time of Death: County of Death: Relationship: Time of Death:. 2014;000698. 68 years Lincoln Interval: 1 Month Decades 20:00 (Actual).