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AFFIDAVIT FOR COLLE DISTRIBUTION ~'-~. J ~ ~',
DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S~ ~¢~'~ ~?,,,., ~,~ ,:~
STATE OF WYOMING
COUNTY OF LINCOLN
!, W. Tom Davis, 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 sole distributee, as
hereinafter set forth, and that I make the following statements in connection therewith'
That Doyle Child aka Francis Doyle Child aka Doyle F. Child became
deceased On February 23, 1996, in Lincoln County, State of Wyoming; that said
decedent died testate; that I am a son-in-law of the decedent and the trustee of
the Doyle F. Child Family Living Revocable Trust dated June 1, 1992; that I am
the sole and only party entitled to the estate of the decedent in accordance with
the laws of the State of Wyoming.
That the value of the entire estate of said decedent, wherever located, does not
exceed $70,000.00."
That more than thirty (30) days have elapsed since the date of death of the
decedent.
That no application for the appointment of a personal representative of said
decedent is pending or has been granted in any jurisdiction.
That the 'following named distributee, is the sole and only party 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 distributee is
entitled to payment or delivery of all of decedent's property:
Name
W. Tom Davis
Relationship
Son-in-law and Trustee
010
That among the assets owned by said decedent was the following:
Zions First National Bank Time Certificate of Deposit No. 319364,
dated March 16, 1994, face amount $2,000.00, deposited by WY Dept
of Environmental Quality, Land Quality Div, but endorsed to 'Doyle
Child.
The proceeds from this time certificate of deposit are due and payable to the
undersigned.
That attached hereto and incorporated herein by this reference is a certified copy
of the death certificate for the decedent.
That the original of this affidavit is being filed of record in the office of the County
Clerk of Lincoln County, Wyoming, in compliance with W.S. 2-1-201(c), as
amended.
EXECUTED as of this 10th day of December, 2002.
VV: T~m 'Davis ( ' '
Subscribed and sworn to before me by W. Tom Davis, this _//~;/~/ day
December, 2002.
Witness my hand and official seal.
(3ER^LD L~ abULDINGII
Notary Publlo - 8t~ of Wyomln~
U.~ol. Coumy, Wyoml,~
I~, intuition Ex,plr~ May ~,
NOTARY PUBLIC.
My commission expires: //j,'~/cD, c*/hZ~
/
of
01 3538
0!1
::::',:~;This is a true and exact re ~)ffice of Vital Records
Date Issued: APR ;2 3 2001 ':''''
':'~: ~epdty !
DOYLE
This copy is not valid unless it bears a
multicolored security paper.
ST^TE m, wYO~G ,
DEIMRTMENT ~F:HBALTH"
CERTIFICATE OF DE~TH
AFTON ,' '
CRTLD
CHILD'