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AFFIDAVIT FOR COLLECTION AND DISTRIBUYJ~N'O~ .'~ ~ ~.~
DECEDENT'S PERSONAL PROPERTY PURSUANT
STATE OF WYOMING ~oo~
COUNTY OF LINCOLN
I, Craig M, Laker, 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:
'3.
That Matilda Clara Laker became deceased on November 4, 2002, in
Bonneville County, State of Idaho; that said decedent was a resident of Etna,
Lincoln County, Wyoming, at the time of her death; that said decedent was
single at the time of her death; that said decedent died testate; that I am the son
and only child of the decedent; and 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 $150,000.00.
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 Relationship
Craig M. Laker Child
380
6. That among the assets owned by said decedent was the following:
The following Scudder Investments accounts:
Name of Fund
High Yield
U.S. Government Securities
Growth
Fund-Account #
08-9334625640-2
18-9334625640-2
03-9334625640-2
All of the above accounts should be transferred 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 6th day of January, 2003.
Subscribed and sworn to before me by Craig M. Laker, this ¢¢ day of January,
2003.
Witness my hand and official seal.
) Unooln ~ wyoming ~
My commission expires:
2
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'Local Reg. No. ~'"~7
i2002
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· This is~,~ tru'p .and,
on file wlth'th~
DATE_!ss~D:;
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a d6cument:.'e~fl~ ally reg st~'(~d end plac~
4EALI'H POLICY.AND. VITAL STATISTICS,
engraved border
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