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Home My WebLink About978591AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2 -1 -201 978591 9/29/2014 2:28 PM LINCOLN COUNTY FEES: $24.00 PAGE 1 OF 5 BOOK: 840 PAGE: 411 AFFIDAVIT JEANNE WAGNER LINCOLN COUNTY CLERK THE STATE OF WYOMING ss. COUNTY OF LINCOLN 11111111 IIIIII Ills 111111 IIIII 11 II I III IIIII IIIII IIII! IIIII IIIII IIII II 1 III IIII IIII Lorraine Brown, being first duly sworn, on oath deposes and states that she is making this affidavit pursuant to W.S. 2 -1 -201 and that she makes the following statement in connection therewith. 1. That Lewis Lee Brown, Jr. a /k/a Lewis L. Brown died on or about the 19th day of August, 2011 in Kemmerer, Lincoln County, State of Wyoming, all as is evidenced by a certified copy of the Certificate of Death which is attached hereto, marked Exhibit "A" and by this reference incorporated herein and made a part hereof. 2. That at the time of his death, Lewis Lee Brown, Jr. a /k/a Lewis L. Brown was a resident of Lincoln County, Wyoming. 3. That Lewis Lee Brown, Jr. a /k/a Lewis L. Brown and Lorraine Brown were married to each other at Ogden, Weber County, Utah on April 5 1968 and were husband and wife continuously from said date until the death of Lewis Lee Brown, Jr. a /k/a Lewis L. Brown. 4. That at the time of his death, the said Lewis Lee Brown, Jr. a /k/a Lewis L. Brown held certain personal property in Lincoln County, State of Wyoming; 5. That the value of the entire estate of said decedent, wherever located, does not exceed Two Hundred Thousand and No /100 Dollars ($200,000.00). 6.. That more than thirty (30) days have elapsed since the date of death of the decedent. 7. That no application for the appointment of a personal representative of said decedent is pending or has been granted in any jurisdiction. 8. That the following named distributees or heirs are the only parties entitled to the estate of the decedent, and that there are no other distributees or heirs of the decedent having a right to succeed to any of the property of the decedent under probate proceedings: Name Relationship Age Lorraine Brown Wife Legal P.O. Box 251 Kemmerer, WY 83101 Lewis Shane Brown Son Legal 1 Ramshead Circle Rock Springs, WY 82901 Travis Lee Brown Son Legal 29 Lost Wells Circle Riverton, WY 82501 9. That Lorraine Brown, Lewis Shane Brown and Travis Lee Brown are the only surviving heirs at law of Lewis Lee Brown, Jr. a /k/a Lewis L. Brown held, deceased, and are, therefore, entitled to payment or delivery of all of decedent's property. 10. That among the assets owned by said decedent is the following: 1977 Titan 14 x 66' Mobile Home, VIN# 407771S 2 590, with an approximate value between $2,500.00 to $3,950.00 based upon comparable models advertised for sale. Original title Number 12- *07753 *number unreadable), issued on August 10, 1983. Check No. 116850 in the amount of $791.48 issued by FTC v. American Tax Relief, c/o Gilardi Co. LLC. 11. That Lewis Shane Brown and Travis Lee Brown have assigned, transferred and set over to Lorraine Brown their right, title and interest in and to the above personal property owned by Lewis Lee Brown, Jr. a /k/a Lewis L. Brown, deceased, as is evidenced by their Assignment and Waivers attached hereto marked "Exhibit B -1 and B -2" and by this reference made a part hereof. 12. That the original of this Affidavit is being filed of record with the County Clerk of Sweetwater County, Wyoming, in compliance with W.S. 2- 1- 201(c), as amended. EXECUTED, this day of Se. o j 2014. LORRAINE BROWN THE STATE OF WYOMING ss. COUNTY OF SWEETWATER The foregoin In trument was acknowledged before me by Lorraine Brown this day of 2014. WITNESS my hand and official seal. JOYCE FRETWELL- NOTARY PUBLIC IOUNTY OF SWEETWATER MY COMMISSION EXPIRES STATE OF ING ear My Commission Expires: ate:and-Place of Death:' ates)f Death: August 'is, 2011 Citjof Death: Kemmerer Location 258 S. County Rd. 342 A dditional Decedent Information: lace of Birth: Ogden, Utah Residence .Kemmerer, Wyoming 'Marital Status: Married Lorraine Porter arne Father: Lewis Lee Brown Jame of Mother Louise BettY;Larsbri V: rifOrMent: Lorraine Brown Relationship Burial Cokeville Cemetery Cokevi,Ile ;Oyorning Ball Family Chapel vanietbri,'WYcitning use of Death a-nittiediate causelslistecton the first line' Cause's. therSignificant. .Brain tumor, Lung Cancer, 0diftent: antler of Death: Natural Death' .4,03.1e" .epy, erggikititVer ri ',IA 1 itaNg$ Ir 1 .,p4-41 n .ertg'axt.,`,4,¢taPil?, .c••• 144,„:=-4,;‘,•A O'N.,,OF VITAL R 1 `4 41 1 4r*t ERTIFICA EfOJW Lewis Lee:BrOwnJe Male August 26, 1944 Physician Jeremy Starr, M.D. P.O Box 390, Kemmerer, Wyoming, 83101 August 36;--2011 This is a true certification of the document on file in the office of Vital Statistics Services; Cheryenne, Wyoming. rbATEISSUED: Friday, September 16,2011 1':-!...i is notyalid unless prepared en paper with an engrayedborder. CERTIFICATEOF State File Number: S,oCial Number: Age at the Time ofDeath: County of Death 2011-002532 Lincoln Matthew T..Rowe Interim DepUtvState'Registrar Ce K. Broodon 5tattigistmr ASSIGNMENT AND WAIVER I, the undersigned, Lewis Shane Brown, of 1 Ramshead Circle, Rock Springs, Sweetwater County, State of Wyoming, one of the heirs at law and next of kin of Lewis Lee Brown, Jr. a /k/a Lewis L. Brown, deceased, late of the County of Lincoln, State of Wyoming, do hereby assign, transfer and set over to my mother, Lorraine Brown, my right, title and interest in and to the following personal property, owned by Lewis Lee Brown, Jr. a /k/a Lewis L. Brown, deceased: 1977 Titan 14 x 66' Mobile Home, VIN# 407771S 2 590 (Original title Number 12 *07753 *number unreadable), issued on August 10, 1983.) Check No. 116850 in the amount of $791.48 issued by FTC v. American Tax Relief, c/o Gilardi Co. LLC. DATED this /7 day f x(11 Y 2014. THE STATE OF WYOMING COUNTY OF SWEETWATER The foregoing in ru ent was acknowledged before me by Lewis Shane Brown this /g4 day of 2014. WITNESS my hand and official seal. JOYCE FRETWELL NOTARY PUBLIC e' COUNTY OF SWEEONATER STATE OF o ING MY COMMISSION EXPIRES ss. My Commission Expires: t i&c4- /S- ASSIGNMENT AND WAIVER I, the undersigned, Travis Lee Brown, of 26 Lost Wells Circle, Riverton, Fremont County, State of Wyoming, one of the heirs at law and next of kin of Lewis Lee Brown, Jr. a /k/a Lewis L. Brown, deceased, late of the County of Lincoln, State of Wyoming, do hereby assign, transfer and set over to my mother, Lorraine Brown, my right, title and interest in and to the following personal property, owned by Lewis Lee Brown, Jr. a /k/a Lewis L. Brown, deceased: DATED this MY COMMISSION EXPIRES 1977 Titan 14 x 66' Mobile Home, VIN# 407771S 2 590 (Original title Number 12- *07753 *number unreadable), issued on August 10, 1983.) Check No. 116850 in the amount of $791.48 issued by FTC v. American Tax Relief,'c%o Gilardi Co. LLC. STATE OF day of THE STATE OF WYOMING ss. COUNTY OF-FECAttlficTS'w6e71V4 My Commission Expires: 20/J' 2014. TRAVIS L E BROWN The foregoin inst ume t was acknowledged before me by Travis Lee Brown this day of 2014. WITNESS my hand and official seal. JOYCE FRETWELL NOTARY PUBLIC COUNTY OF SWEETWATER AG