HomeMy WebLinkAbout977039AFFIDAVIT FOR DISTRIBUTION
OF DECEDENT'S PERSONAL PROPERTY
PURSUANT TO W.S. 2 -1 -201
977039 6/16/2014 10:47 AM
LINCOLN COUNTY FEES: $18.00 PAGE 1 OF 3
BOOK: 834 PAGE: 183 AFFIDAVIT
SS. JEANNE WAGNER LINCQLN COUNTY CLERK
111111111111111111111111111111111111110111111111111111111 1111 IIII
I, MARVIN G. SCHWAB, being first duly sworn, on oath depose and state that I
am making this Affidavit pursuant to W.S. 2 -1 -201, on behalf of myself, as distributee
as hereinafter set forth, that I make the following statements in connection therewith:
STATE OF WYOMING
COUNTY OF LINCOLN
1. That JEANNE M. SCHWAB became deceased on December 29, 2013 in
Afton, Lincoln County, State of Wyoming, and was a resident of Afton, Lincoln County,
State of Wyoming, at the time of her death; that said Decedent died intestate; that said
Decedent left Marvin G. Schwab, as surviving spouse; that the sole and only party
entitled to the estate of said Decedent is the distributee hereinafter named; a copy of the
Certificate of Death of Decedent is attached hereto as Exhibit "A
2. That the value of the entire estate of said Decedent, wherever located, does
not exceed $150,000.00.
3. That more than thirty (30) days have elapsed since the date of death of the
Decedent.
4. That no application for the appointment of a personal representative of said
Decedent is pending or has been granted in any jurisdiction.
5. That the following named distributee is the sole and only party entitled to
the estate of the Decedent, that there are no other distributees of the Decedent having a
right to succeed to any of the property of the Decedent under probate proceedings, and
that therefore, the following named claiming distributee is entitled to payment or delivery
of all of the Decedent's property:
Name Relationship
Marvin G. Schwab Spouse
6. That among the assets owned by said decedent are the following:
2003 GMC UTLP, VIN 1GKFK16Z33J241621
2008 Mercury 4DR, VIN 2MEHM75V68X604524
Affidavit for Distribution
Page 1 of 2
2003 ARCFO HSE, VIN 4N11U302130118883
7. That an executed copy of this Affidavit is being presented to the transfer
agent for the above listed asset in compliance with W.S. 2 -1 -201. Furthermore,
pursuant to W.S. 2 -1 -201, the depository for any income or interest in the above
entitled asset is hereby directed to pay any deposit or any funds in said account that were
in the name of the Decedent, together with any interest and dividends thereon, payable to
distributee listed here.
Name Address
Marvin G. Schwab P.O. Box 106
Afton, WY 83110
EXECUTED this 2 day of lit t EJ 2014.
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
SUBSCRIBED AND SWORN to before me, a Notarial Officer, by MARVIN G.
SCHWAB this /2- day of J({ EI e 2014.
CRYSTAL L. SLAUGHTER NOTARY PUBLIC
County of State of
Lincoln Wyoming
My Commission Expires February 3, 2018
My Commission Expires: -(3( (4
!I v
1VIARVIN G. SCHWAB
Address: P.O. Box 106
7
Afton, W Y 83110
(IVI4 L_VitA
NOTAItY PUBLIC
Affidavit for Distribution
Page 2 of 2
Decedent:
1 4. 6111 P:
der:
Date of Birth:
Date and Place of peat
6ate of Death:
Cinfof Death:
CbCation:
Additional,DeCedent inform
PlaCe'of.Birth:
Residence
Marital Status:
Armed Forces:
arrie of Father!'
Nellie of:Mother:
InfOrrnaht:
Iposition:
effhod of Dispdaition:
Piaie of Disposition:
....0thegnificant
Qonditiofls
Manner Of Deati:
Certifier:
Type:
Name:
.i:Addsal..
Date Filed:
Wfire.01tAl
Wit: ei EP ffLbaVng Wifiggar Pf tWI ftrfl e l? 4
1 4 1 „4/ T IF
CERTIFILATION rm_ RcoR.D
STATE OF
Jeanne Moser Sch)Aiab
Ferriale
June 04, 1938
December29, 2013
Afton
£37601Hwy289
DEPARTMENT OF HEALTH
CERTIFICATE Of DEATH
ation:
Montpelier, Idaho
Afton, Wyoming
Married Marvin G. Schwab
No
Seth Lorin Moser
Alice' Lucille Ebom
Marvin G. Schwab Relationship:
Burial
Auburn Cemetery, Auburn, Wyoining
Filneral Home or Facility::
Schwab Mortuary, Afton, Wyoming
Of Death:
The imniediate::c awe is listed on the first line follciived by ank.underlying,catjses::
(a)Gastrointestinal bleeding
Dementia, parkinsonism
Natural Death
:Physician
Allen D. Carter, M.D.
'110 PC Box 579;Afton, Wyoming;83:110
January 16; 2014
74519.3:
-This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming
DATISSUEDFriday, January 20
,This copys not.valid pi leq prepared (nipper withan engraved border.
.1
State File Number:
SocialSecOty:Nuniber:
Age at the Time of Death:
County 8f Death
Time of Death.-
mita alstms.t.,
2013-004150
.75 years
Lindbln
,t
weeks
Husband
14:30 (Adtual)'
eviif.05
James McBride
Deputy State Registrar
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