HomeMy WebLinkAbout906149 AFFIDAVIT FOR COLLECTION AND DISTRIBUTION OF
DECEDENT'S PERSONAL PROPERTY PURSUANT TO W.S. 2-1-201
RECEIVED 1/31/2005 at 10:20 AM
STATE OF WYOMING RECEIVING # 906149
ss. BOOK: 578 PAGE: 54
COUNTY OF LINCOLN JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
I, Patricia C. Davis, being first duly sworn, on oath depose and state that i am making this
affidavit pursuant to W.S. 2-1-201, in behalf of myself and my brother and sisters as the heirs at
law and distributees, as hereinafter set forth, and that I make the following statements in
connection therewith:
That Elaine C. Child aka Elaine Clark Child became deceased on August 3, 2004, in
Alton, Lincoln County, State of Wyoming; that said decedent died testate; that I am one
of the daughters of the decedent; that the individuals listed in Paragraph 5 below are the
only parties 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.
The following named distributees are the only parties 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 distributees are entitled to payment or delivery of all of
decedent's property:
Name Relationship
Patricia C. Davis Daughter
Betty Child Daughter
Robed D. Child '. Son
Susan Child Daughter
1
6. That among the assets owned by said decedent was the following:
Wells Fargo Bank Saving Account No. 371-1283810
The amount in this account is now due and payable to the distributees
named above.
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 28th day of January, 2005.
Patricia C. DaVis
Subscribed and sworn to before me by Patricia C. Davis, this ~;:~e'P/4 day of
2005.
/
Witness my hand and official seal.
County o~ ~¢.~1It' St.te of
Lincoln ~ Wyoming
My Commission Exoires May 2, 2007
My commission expires:
2
STATE OF WYO. MING
~[)(]J ~L-~I'i~A'/~} DEPARTMENT OF HEALTI~: :: ! '~'~',~.)~ ~ ~"1~,,~"' ~ 6
STATE OF WYOMING '~
: : :'i- "i::~ ':: !:DEPARTMENT ~ i. "'i!!:: ':: : ?
OF HEALTH, -
LOCAL FILE NUMBER¢'''j''''~
CERTIFICATE OF DEATH ...L s:rA~E FILE NUMBER
5~. XGE'-- Lasl ~'~ay :: 5~. UNDER {'YEA~ :' ~.~ND~ } DKY :5 ~.. DATE OF BI~TH (M~y~r} ::. : " :'
's°520_20_1966' ......... ; (...,.) 8~ "~' "'~;.I ~i .~,; ~RCH 29, 19~4 " ..:
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STAR VALLEY CARE CENr~ ' ,";~: :/,:~'~:AFTON /"''' ~ L{NCOLN
O,ES ~ ~OMING ,:':: -. ': ' LINCOLN-:;>, 7:_, q '" '~ 'AFTON ·
110 HOSPITAL :~:L~E' ~' : .~: '~ "':' ".'?:' ---:'!~[L';" '?:~.:" ?:~:: ;; 8~1i:~ ~.. ~;~s:.;~
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GEORGE RULON CLARK . ' ' - : , .ALDAL-NIXON ~' [~: ':~
~c . ' ~ ~ AFT ~ CEMETERY '~ AFTON, ~OMING
' 18~o:;,::.~:, ..... = XucUsT 3, '2004 :. .1. ~8~0 ' ' :'~J
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This is a true anti exact reproduction of the document on file in the office of Vital
Records Services, Cheyenne, Wyoming.
12 ,"~':b:~: ;:~ ?: .;' ....
'~;UG ::: "~''' ;:~ ::~~
DATE
ISSUED:
AUG 12 2004
Lucin~Ja McCaffre~; ::: / :::
Deputy State Registrar