HomeMy WebLinkAbout9795794. 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 distributees are the sole and only parties 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 distributees are entitled to payment or delivery of all
of the Decedent's property:
AFFIDAVIT FOR DISTRIBUTION
OF DECEDENT'S PERSONAL PROPERTY
PURSUANT TO W.S. 2 -1 -201
979579 12/5/2014 10:14 AM
STATE OF WYOMING LINCOLN COUNTY FEES: $18.00 PAGE 1 OF 3
BOOK: 844 PAGE: 320 AFFIDAVIT
SS. I I JEANNE WAGNER, LINCOLN COUNTY CLERK
COUNTY OF LINCOLN
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I, MICHAEL JAY HENRIE, 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 a distributee, as
hereinafter set forth, that I make the following statements in connection therewith:
1. That ROGER J. HENRIE became deceased on August 13, 2013 in Etna,
Lincoln County, State of Wyoming, and was a resident of Etna, Lincoln County, State of
Wyoming, at the time of his death; that said Decedent died intestate; that said Decedent left
Michael Jay Henrie, Troy Lee Henrie, and Christina Salas as surviving children; that the sole
and only parties entitled to the estate of said Decedent are the distributees 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 $200,000.00.
3. That more than thirty (30) days have elapsed since the date of death of the
Decedent.
Name Relationship
Michael Henrie Son
Troy Henrie Son
Christina Cornelison Daughter
6. That among the assets owned by said decedent is the following to be
distributed to Troy Lee Henrie:
Affidavit for Distribution
Page 1 of 2
2003 Dodge Pickup, VIN 1D3KU28DX3J56305
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.
EXECUTED this 1 day of 2014.
My Commission Expires: 2\ 51 11
CRYSTAL L. SLAUGHTER NOTARY PUBLIC
County of State of
Lincoln e Wyoming
My Commission Expires February 3, 2018
MICHAEL HENRIE
Address: P.O. Box 5131
Etna, WY 83118
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
SUBSCRIBED AND SWORN to before me, a Notarial Officer, by MICHAEL
HENRIE this k day of 0cctob 2014.
WITNESS my hand and official seal.
Affidavit for Distribution
Page 2 of 2
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