HomeMy WebLinkAbout890506Jerry T. Harmon
That the decedent, Jack
of May _, 20 03
c'~ g.9' LINCOI N COUNTY_CLERK
890506
Affidavit of Distnbume for , ' " ~'.
Transfer of Wyoming Ce~ificate of Title
, berg ~st duly sworn and upon my oath, state the foUowing~
B. Harmon , died on ~e 8th da~
. (a codified copy of dea~ ce~ficate must be a~ched to t~s fo~)
Thatthename(s)~fthedis~utee(s)entit~edt~payment~rde~ivery~fdecedent~spr~pertyis/are:
Name(s):· Relationship
Juanita H. Price Daughter
jerry T. Harmon Son
Daughter
Jeraldine H. Lloyd
That the value of the entire estate of the decedent, wherever located, less liens and encumbrances,
dges not exceed~ *~.~ .... a a_.~__ ($7.O~,, ' 3
That more than thirty (30) days have elapsed since the date of the decedent's death.
That no' application for appointment of a personal representative is pending or has been granted in any
jurisdiction.
That the above-named distributee(s) is/are entitled to-payment or delivery of the decedents property
and there are not other distributees of the decedent having a right to succeed to the property under
probate proceedings.
7,
That the undersigned request that the following described property be transferred
to:_ Jerry T, Harmon [names(s)] as
surviving son
[relationship(s) of said decedent, and that titles to said motor vehicles be transferred into said name.
(title application must be I-filed out)
Property description:
-Y-~a.r M4~k..~F~ -C..olo~ ~hhal~-~ati~N~_
Checking Ac'count .11 00107 0 at First National Bank '
Warranty_Deed - Recorded August 16, 1988 No. 691719
DATED this 6'th day of ' June ,2003
~//"Sta~e ~yo~g -- >- ,
County of Lincoln )
Before me personally appeared Jerry T. Harmon "
, being first duly sworn by
me upon Ns/her oath says that the facts alleged in the foregoing instrument are lame. Witness my hand and
official seal.
.Seal
Notary Public or-Aaaisiant Cuunty-C-lerk'
· STATE'oF:UTA~.': DEPARTMENT OF HEALT~4~,~{~{ ~
za 20a~' "'?CERTIFICATE OF DEATH
~aA::,2, t9,7 I 86 J.e.*",.[~.,~ I"*' IM'''' Fairvlew, Wyoming I 520-0?:3354.
t~*f~Yl ~ ~ I~ ' *~ .... n- H-~e Care Source .: ?;, :';;:: ..
SaR Lake Ci~ ~ Salt Lake
~;~..~,, ~2.,oI D2. u,,d* ~4. o,,,,* [ S'o~*. Conservation Agent I Agriculture
P.O. Box 127 ' ,C0keville Lincoln Wy0mi~g
'~Z ,o ~. P..~o ai~ ~4, o~,(s~l Caucasian · 12':';'. :'; .'
~.gsse FATHER'S Ha~on ~E (Fi¢,l Middl,. Lasl) : . la. ~'O~N Mary NAME OF MOrnER Estella(F~'( ~.Bro~ La~,)
DAUGHTER: Juanita Price / 201 No~th 650 East / ~ountiful, Utah 84010
~4;"u,., Qs.c.m.,..~*.* .... IMay 16, 20031Cokeville City CemeteryI Cokeville, Wyoming
;.:-X9~/~'" -94-116103 Matthews Mortuary;:;
,~.oAT~ec~sEowACs* 2~.,.ot~ti~.~,~l~l~,¢~.,**,~.*~.~m~.m~ ~ ~ ~ *o 702 Clay
'" : ' 200300682 Montpelier~. ICahe.'.
.: ~,~ c;..& **. .o o.~ YEA* ~ 83:254'
~dwaro A;.Le,s, Mu. Asst. Mea. examiner q~meo,ca, ur. Salt Lake Ci~, UT 84113 ~
~1, FARII. ENTER THE OlS~SES, INJURIES, OR COMPU~O~T~USED~E O~TH. OO NOT ENTER THE MOOE OF DYING, SUCH AS CARDIA~ ' ~atelnts~al
' QR RESPIRATORY ~RREST, SHOCK, OR H~RT FAIL~ UST ONLY ~lE CAUSE ~ ~CH UNE. :;
NATURALDIS~SE NOT OTHERW SE SPEC F ED
inlUaiad evanB ~ulUng In DUE TO OR AS A CONSEOUENCE OF): : :: : :~ .:,:::~:.:".: .
dea h LAST ' ': : ':':: '.
" d. I' . :~.::
. DUE TO (OR AS A CONSEQUENCE OF): · {: : ':
~utnu esul ng ~ heundeyng~usegiven nPa~l ~ PERFORMED1 : FINDINOSAVAI~BLE
F USER :
:
~ S. Un~le~i~ ~ ~"~3~E~R~EH~WNJU~Y~URRE~(w~s~¢~m~n~x~TURE~F~NJURY¢~b~f)'
is a true copy of the certificate on file in this office, This certified copy is issued
26-2-22 of the Utah Code Annotated, 1953 As Amended.
' i':_ Barry E. Nangle
· DIRECTOR OF VITAL RECORDS
* 0 I 2 4 5 7 6 0 *