HomeMy WebLinkAbout977874STATE OF WYOMING
COUNTY OF t- "704
In the Matter of the Estate of
6 f 3h71/ShA/}
Decedent v
1. My mailing Address is:
Ao. fox3 7 'I/
Street Address
City State
1;2g
Zip code
My Residence Address is:
)1hied d/r
2. The decedent's full name is:
Street Address
Suer 0E1/ ,4 toy
City, State
g3/7
Zip code
NO
AFFIDAVIT OF SMALL ESTATE
DISTRIBUTEES
I e o''7/7/ e_ v, k//7 upon duly sworn, state on my oath on behalf of myself and
all other distributees, th
66 -q MGLSon /4:9/)/449-7
3. More than thirty (30) days have elapsed since decedent's death. The date of the decedent's
death was h, I i t 3, ?-d 1 L4 I have attached a copy of the
death certificate hereto
4. I am a distributee of the decedent's estate as defined in Wyoming's Statutes 2 -1 -301 (XIII).
All distributees of the decedent, including myself, are listed as follows:
977874 8/6/2014 10:47 AM
LINCOLN COUNTY FEES: $21.00 PAGE 1 OF 4
BOOK: 837 PAGE: 405 AFFIDAVIT
JEANNE WAGNER LINCOLN COUNTY CLERK
IIIIIIIII 10101 III IIII I011 II0 1 111111
IN THE DISTRICT COURT
JUDICIAL DISTRICT
11 0
Surviving Spouse: Bonn j 8 M,g h ann
Relationship:
Address: Rp, gO)( 374
City: ic i
State: 1,0 t U Vri
Zip code: g
Relationship: Da;,t i
Name: 3�. inr)I �r°r 63{1 -YY1
Address: P.0 f2nk 3 7
Cit 1 9-i0 1 nP
State: l,) 1 y/
Zip code: 2 A g
DOB: (minors only)
Relationship: Soh
Name: M(SOIn 8, 171 A a
Address: 7& 7 3, 5" s,
City: c i Fe s
State: HA p
Zip code: F3 4 i p
DOB: (minors only)
Relationship:
Name:
Address:
City:
State:
Zip code:
DOB: (minors only)
Name:
Address:
City:
State:
Zip code:
DOB: (minors only)
5. That the value of the entire estate of the decedent, wherever located, less liens and
encumbrances, does not exceed One Hundred fifty Thousands Dollars ($150,000.00).
6. No application or petition for the appointment of a personal representative is pending or has
been granted in any jurisdiction.
7. The claiming distributes are entitled to payment or delivery of the property, and there are no
other distributes of the decedent having a right to succeed to the property under the probate
proceedings.
Under penalty of perjury, I /We declare that I /We have read the foregoing and the facts alleged
are true, to the best of my /our knowledge and belief.
Date:
og/05
Print Name of Petitioner: Roil n I U. h6 &ryl
Address: P X .3 741
City:
State: /4)
Zip code: 9' j g
Phone:
Zip code:
Relationship to Decedent: trU: Viva £po Gcse,.
State of Wyoming
County of
The follow'
2011 by
(seal)
instrument was acknowledged before me this day of a
n kf I+ 34._
No ary P
_Lee, tivt
Printed Name
LEE R. DENNIS NOTARY PUBLIC
County of
Lincoln
State of
Wyoming
MY PArnrniP$ion Expires August 2
My commission Expir
Signature of Petitioner:
Acknowledgement
z/4/4/4,)
Cremation
Schwab Mortuary Crematory,'1
CERTIFICATE OF.
State File Number:
Social, .Security Number.
Age at the Time of Death:
Relationship:
2014- 002020
56 years
Wife
Appreximate'23 00' #'1 hr
anna /YI` 4e4,
James McBride
Deputy State Registrar
t ilt s o.r xnmj tv r ,n ie r,:1y <r...ox� c 5, .>^..r•; c. it •.zx. fil rd n :1:C.. sf. 4:45 r s /1j
1a ::cru. ,r.r
��q P y ir j,���- .i yi p! STt t p' r r 5� g� b
W Ii g 3 ��'Q� R r 1/ sF. u cF i Y� 3 Tr7 1 Tfr ::l�i �VS� aTdl
CERTIFICATION OF
VITAL RECO.RD?,
ecedent:
erne:
;Date of Birth:
ate an d Place of Death::
Date of; Death'
City of.Death:
Location:
(a);Cervic j,Fracture
i ther Significant.
ondittans
anner of D�atfi
983:
Gary Mason Higharn
Ma:(e
December 16, 1957
July 03;2014
Star Valley Ranch
St ValleyRanch
f ditionalb'ecedent Information:
Place.�of.Birth:.
esldenee
arital Status:
rmed -Forces:
acne of Father:
me`of Mother:
Informant:
spostion
ethod of Disposition:
ace: of :Disposition:
unerai Home or `Facility:
Facility:
ause ,of`Death.
he imrriedlate cause is listed on the first line followed by any underly.,fng causes.
Idaho Falls, Idaho
;Star Valley Ranch, Wyoming
Married Bonnie Virginia' Nash
No
Leo'Higham
Shirley Irene`Mason
Bonnie Virginia Higham
Schwab Mortuary, Afton, Wyomihlg
Tension Pneumo Hemo,Thorax
Accident
)miry Information:
Date Of. Injury: July 03 2014 (Actual) Time Of Injury:
Injury AtWur{\% No
Location:: Star Valley Ranch Star Valley Ranch, Wyoming
escnption ATV rollover
ertifier:
ype:- Coroner
Name: Michael Richins, Coroner
Address: 274 N St, Box 57 Grover Wyoming, 83122
Date. Filed: July 08, 2014
This is a true certification of the document on file in the office of Vital
Statiefics Services ciheyenne, Wyoming.
-DATE "ISSUED: Friday July 18•;.2014
.:This pop noh,valid. unless ..prepared op paper with an engrayed