HomeMy WebLinkAbout979580AFFIDAVIT FOR DISTRIBUTION
OF DECEDENT'S PERSONAL PROPERTY
PURSUANT TO W.S. 2 -1 -201
979580 12/5/2014 10:24 AM
STATE OF WYOMING LINCOLN COUNTY FEES: $18.00 PAGE 1 OF 3
BOOK: 844 PAGE: 323 AFFIDAVIT
SS. JEANNE WAGNER LINCOLN COUNTY CLERK
COUNTY OF LINCOLN
11111 IIllll 11 11111 II 111111111111 III 1 111111111111 II 1 II l l11 1111
I, SHERRY MERRITT, 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:
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 Sherry Merritt, as a surviving child; 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 $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 distributee 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
Sherry Merritt
Spouse
Daughter
6. That among the assets owned by said decedent is the following:
1992 Chevrolet PU, VIN 2GCFK29KON 1146480
Affidavit for Distribution
Page 1 of 2
r
l
Name and Address Address
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
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.
Sherry Merritt P.O. Box 651
Afton, WY 83110
EXECUTED this day of December, 2014.
ERRY MER
SSN:
Address: P.O. Box 651
Afton, WY 83110
SUBSCRIBE AND SWORN to before me, a Notarial Officer, by SHERRY
MERRITT this day of December, 2014.
CRYSTAL L. SLAUGHTER NOTARY PUBLIC
County of
Lincoln
State of
Wyoming
My Commission Expires February 3, 2018
My Commission Expires:
NOTARY PUBLIC
Affidavit for Distribution
Page 2 of 2
Deputy State Registrar
decedent:
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CERTIFICATION OF VITAL RECORD'
Geniier:
Date of Birth:
Date and Place of Death:
'bate of Death:
City of Death:
Additional .0 6 6eden tinfOrm'
Place of Birlh Montpelier Ida
ResldenQe Afton Wyoming
Marital Status 1)/1 Schwa
Armed Forces No
Name o Father Seth Lorin Moser
Narte4fii4Other:
Informant. Marvin
D isposition:
'hod •of bisposi b rn Cemetey Auburn
Funeral e or Facdity
Schwa M
The '',,,:Cause•Oftleath:•
imrii0diatcaase IS.list0160 first line:tollAwecl any underlying
(a) Gastrointestinal
e of Disposition
Oondittons
•Manner
Oerhfier:,
Name:
Address .1
Date
T-174.5"1961ili.
This is a true certification of the document on file in office of Vitat
:StatisticaSenfices,•phoyenne,WyomIng
.7 :DATE:1$SUED:Friday, JarltJaryl7;'•"2, 014
is dopy...is noiNalid•Nnlessptepaied oripiper
'IW'r11TR!rP!fRlrrr.SIS•GTI•Mlrrelq1RTF1.Mc.
MOSeri:Schygeb
Feniale
June 04, 1938
December 29 2013
Afton
Natural Deth
.::::..DOPARTMENT'OF".::171EALT
...„••••••cERTIFicqE.oF•••pATs-...,..•:
:State Fiie Number:-
Age at th? Time :of Death'.
Physician
Allen D. Carter, M.D:.
10
ount; of Death
niedf
-2013-004150
75 years