Fill and Sign the Wy Estate Form

SMALL ESTATE AFFIDAVIT Collection of Personal Property or Instruments Evidencing Debt Wyoming Statutes Title 2, Ch. 2, Art. 1 Section 2-1-201 through 2-1-205, inclusive Control No. WY-ET10 1 STATE OF WYOMING ) IN THE DISTRICT COURT ) s.s.       JUDICIAL DISTRICT COUNTY OF       ) No.       In the Matter of the Estate of ) )       ) ) Decedent. ) AFFIDAVIT OF SMALL ESTATE DISTRIBUTEES I/We,       , upon duly sworn, state on oath, on behalf of myself and all other distributees, that: 1. My mailing address:       Street Address       City, State       Zip Code My residence address is:       Street Address       City, State       Zip Code       Street Address       City, State       Zip Code My residence address is:       Street Address 2       City, State       Zip Code 2. The decedent’s full name is:       3. More than thirty (30) days have elapsed since decedent’s death . The date of the decedent's death was       . I have attached a copy of the death certificate hereto. 4. I am a distributee of the decedent estate as defined in Wyoming Statutes 2-1-301(XIII). All distributees of the decedent, including myself, are listed as follows: Surviving Spouse:       Address:       City:       State:       Zip code:       The legal basis upon which the distributee or distributees claim entitlement to decedent’s property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the decedent and from whom the applicant distributee or distributees claim. ___________________________ Relationship: Name       Address:       City:       State:       Zip Code:       DOB: (minors only)       The legal basis upon which the distributee or distributees claim entitlement to decedent’s ___________________________ 3 property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the decedent and from whom the applicant distributee or distributees claim. Relationship: Name       Address:       City:       State:       Zip Code:       DOB: (minors only)       The legal basis upon which the distributee or distributees claim entitlement to decedent’s property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the decedent and from whom the applicant distributee or distributees claim. ___________________________ Relationship: Name       Address:       City:       State:       Zip Code:       DOB: (minors only)       The legal basis upon which the distributee or distributees claim entitlement to decedent’s property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the ___________________________ 4 decedent and from whom the applicant distributee or distributees claim. Relationship: Name       Address:       City:       State:       Zip Code:       DOB: (minors only)       The legal basis upon which the distributee or distributees claim entitlement to decedent’s property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the decedent and from whom the applicant distributee or distributees claim. ___________________________ Relationship: Name       Address:       City:       State:       Zip Code:       DOB: (minors only)       The legal basis upon which the distributee or distributees claim entitlement to decedent’s property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the decedent and from whom the applicant distributee or distributees claim. ___________________________ Relationship: 5 Name       Address:       City:       State:       Zip Code:       DOB: (minors only)       The legal basis upon which the distributee or distributees claim entitlement to decedent’s property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the decedent and from whom the applicant distributee or distributees claim. ___________________________ Relationship: Name       Address:       City:       State:       Zip Code:       DOB: (minors only)       The legal basis upon which the distributee or distributees claim entitlement to decedent’s property, including facts regarding any intervening estates or other parties who may have a claim of entitlement from the decedent and from whom the applicant distributee or distributees claim. ___________________________ 5. That the value of the entire estate of the decedent s subject to administration, either testate or intestate, less liens and encumbrances, does not exceed two hundred thousand dollars ($200,000.00); 6. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 6 7. The person or persons claiming to be a distributee or distributees are entitled to payment or delivery of the property of the decedent 8. There are no other distributees of the decedent having a right to succeed to the property under probate proceedings in any jurisdiction. 9. An application for appointment of a personal representative has has not been made in a jurisdiction outside of Wyoming: If application outside of Wyoming has been made: The name and address of the proposed or appointed personal representative is ________________________________ . The date of the application is ________________________________ . The date of any appointment is ________________________________ The title of the proceedings and name of the court and jurisdiction in which the application was made is ________________________________ . 10. A full description of any real property, including any mineral interests, being claimed is as follows: ________________________________ (a sworn report of value, which may be based upon a broker's price opinion as defined by W.S. 33-28-102 (b)(lxii), made by a person who has no legal interest in the estate, showing the value on the date of the decedent's death of all interests owned by the decedent in real property located in Wyoming, including mineral interests is attached.) Under penalties of perjury, I/We declare that I/We have read the foregoing and the facts alleged are true, to the best of my/our knowledge and belief. Date:       Signature of Distributee: Print Name of Distributee:       Date:       Signature of Distributee: 7 Print Name of Distributee:       Date:       Signature of Distributee: Print Name of Distributee:       Date:       Signature of Distributee: Print Name of Distributee:       Date:       Signature of Distributee: Print Name of Distributee:       Date:       Signature of Distributee: Print Name of Distributee:       Date:       Signature of Distributee: Print Name of Distributee:       Date:       Signature of Distributee: Print Name of Distributee:       Acknowledgement STATE OF WYOMING COUNTY OF The foregoing instrument was acknowledged before me this (date) by . 8 (Seal) Notary Public Printed Name My Commission Expires: 9 STATE OF WYOMING ) IN THE DISTRICT COURT ) s.s.       JUDICIAL DISTRICT COUNTY OF       ) No.       In the Matter of the Estate of ) )       ) ) Decedent. ) AFFIDAVIT OF SMALL ESTATE CREDITOR I, ____________________________________________________________________, upon duly sworn, state on my oath, [on behalf of myself and all other distributees, that: 1. My business/mailing address:       Street Address       City, State       Zip Code My residence address is:       Street Address       City, State       Zip Code 2. The decedent’s full name is:       3. More than thirty (30) days have elapsed since decedent’s death . The date of the decedent's death was       . I have attached a copy of the death certificate hereto. 4. I am a creditor of the decedent owed a debt at the time of death or which would be owed if the estate was being administered upon. OR 10 I file this affidavit in my capacity as       , and on behalf of       , a creditor of the decedent owed a debt at the time of their death or which would be owed if the estate was being administered upon. 5. That the value of the entire estate of the decedent, wherever located, less liens and encumbrances, does not exceed Two-Hundred Fifty Thousand Dollars ($200,000.00). 6. That no application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 7. To the best of my knowledge, no affidavit pursuant to W.S. 2-1-201, in connection with the decedent, has been presented to any party referred to in W.S. 2-1-201. 8. The claim is based upon:       The amount claimed is:       Total Payments to date:       9. I, or the party that I represent, fully and freely: (A) Waive any immunities from suit or levy of execution I/We might otherwise have; (B) Agree to indemnify and hold harmless from all claims whatsoever any party delivering assets on the basis of such affidavit, to the extent of the full value of the assets so delivered; and (C) Is answerable and accountable to a personal representative of the estate, if appointed, or to any other person or party having a superior right. Under penalties of perjury, I/We declare that I/We have read the foregoing and the facts alleged are true, to the best of my/our knowledge and belief. Date:       Signature of Affiant: Print Name of Affiant:             Street Address       City, State       Zip Code       (Area Code) Telephone No.       Relationship to Decedent 11 Individual Acknowledgement STATE OF WYOMING COUNTY OF The foregoing instrument was acknowledged before me this (date) by . (Seal) Notary Public Printed Name My Commission Expires: Corporate Acknowledgement STATE OF WYOMING COUNTY OF The foregoing instrument was acknowledged before me this (date) by , as of . (Seal) Notary Public Printed Name My Commission Expires: 12