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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