HomeMy WebLinkAbout894442 RECEIVED
LINCOLN COUNTY 0LERK
AFFIDAVIT FOR COLLECTION AND DISTRIBUTIO~it~N!:- AGNER
DECEDENT'S PERSONAL PROPERTY PURSUANT TO
STATE OF WYOMING
cOUNTY OF LINCOLN
SS.
I, Joseph A. Busch, 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 distrib'utee, as
hereinafter set forth, and that I make the following statements in connection therewithi
..
That Betty J. Busch aka Bettye Jean Busch, a married woman and resident of
the State of Wyoming, became deceased August 12, 2002, in Idaho Falls, State
of Idaho; that said decedent died intestate; that I am the surviving spouse of the
decedent; that I am the sole and only party entitled to the estate of the decedent
as her surviving i~pouse, in accordance with the statutes of descent and
distribUtion 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
Joseph A. Busch
Husband
1
552
That among the assets owned by said decedent was the following:
Ten (10) limited partnership units according to that certain Certificate
of Limited Partnership Interest No. APX - 1806, Angeles Partners
X, a copy of which is attached and incorporated herein by this
refe re n ce.
All of said decedent's interest in said property should be transferred
into the name of Joseph A. Busch.
That attached hereto and incorporated herein by this reference is a certified copy
of the death certificate for the decedent.
o
That the original of this affidavit is being filed of record with the County .Clerk of
Lincoln COUnty, Wyoming, in compliance with W.S. 2-1-201(c), as amended.
EXECUTED as of this 13th day of October, 2003.
Subscribed and sworn to before me by Joseph A. Busch, this 13th day of October,
2003.
[ My Commission Expires May2, 2007_ ~
NOTARY PUBLIC
My commission expires: May 2, 2007.
2
Date Filed
STATE OF IDAHO-
~'~J~4 ~HO DEPARTMENT OF HEALTH AND WELFAF
' ~,U OF. VITAL RECORDS AND HEALTH STAT
AUGUST 26, 200;
~le No. 2002'~ 060:5
BETTYE
DATE O~ DEATH
'.AUG. 12,
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
NO
RESIDENCE STATE
WYOMING
JEAN BUSCH I~ ~ r
~.~ , r , ". ~', ~:~ ,
FUNERAL SERVICE LICENSEE ..,,
METHOD OF DISPOSITION J i ~i'l ME OF,, ~E~N
I
CRE HAT I ON ' '10:i i;':5 '/~ ;M. ,'=:
' ARDS (ADULT RESPIRATORY',,ID'~'STRi~SS SYNDROME)
COMMUNITY ACQUIRED <,P.,NE HONIA
DU~ TO (or as a consequence of):
OTHER SIGNIFICANT COND TIONS CONTRIBUTING TO D~TH butno ~e~ ang n ~e unde ~ng ~u~ g~ above . - ~- -_ ~
PULMONARY !NTERSTIT._~ !AL FIBROSIS,,'.~.~'~ i -'" - ~-':' .-
,.,2 ELKS
-'R
DAVID L. sHR'X'i~I~:/-SM.D
ACTION
'I'
,,DATE OF INJURY ~ .' I'" ~:~:~:~::~ -
,I ,~,, ,', - JLOCATION OF INJURY
m
I
· ';.; ~'This is a true arid cbrre'b!'repto~Juctibn of the document officially registered end placed
j- ~ bn iiie with th~ IDAH~ ~UF~EAU OF V~ TAL RECORDS A'ND HEALTH STATISTICS.
_: DA;FEIS$~iAUGUST 27, 2002
: "Th~s copy is not vahd unless prepared on engraved border
displaying state seal and ~ignalure of the Registrar. ~_. STATE REGISTRAR
554