IN THE DISTRICT COURT OF THE STATE OF WYOMING,



AFFIDAVIT OF DISTRIBUTION

PURSUANT TO WYOMING STATUTE SECTION 2-1-201

I, _____________________________________ (the “Affiant”) being first duly sworn, do hereby state and allege as follows:

1. I am an adult, over eighteen years of age, and competent to testify.

2. My address is___________________________________________________________.

3. I make the following affirmations on behalf of the claiming distributee(s) of the Estate of ___________________________________ (the “Decedent), based upon my own best investigation, information and beliefs.

4. The value of the entire estate, located in Wyoming or otherwise subject to probate administration in this state, less liens and encumbrances, does not exceed two hundred thousand dollars ($200,000.00).

5. The Decedent passed away on ________________, 20_____. The place of last residence of said Decedent was _______________________________.

6. More than thirty (30) days have elapsed since the death of the Decedent.

7. No application for appointment of a personal representative is pending or has been granted in any jurisdiction in this state.

8. The claiming distributee(s) are entitled to payment or delivery of the property identified herein based upon the following:

a. Decedent died without a Last Will & Testament, intestate, and was survived by the following heirs (the “claiming distributees”) pursuant to Wyoming Statute Section 2-4-101:

Name Relationship to Decedent Percentage

______________________________ _____________________ ___________

______________________________ _____________________ ___________

______________________________ _____________________ ___________

Or;

b. Decedent died with a Last Will & Testament, and pursuant to the terms of the Last Will and Testament, the beneficiaries of the property (the “claiming distributes”) are:

Name Relationship to Decedent Percentage

______________________________ _____________________ ___________

______________________________ _____________________ ___________

______________________________ _____________________ ___________

9. There are no other distributees of the Decedent having a right to succeed to the residue of the estate of the Decedent under probate proceedings, other than set forth in this instrument.

10. The transfer agent for any security shall change the registered ownership on the books of a Corporation from the Decedent, to the claiming distributees in accordance with the percentages stated next to the claiming distributees’ names.

11. The county clerk of the county in which any vehicle is registered, when presented with a copy of this Affidavit of Distribution, shall transfer title of the vehicle from the from the Decedent, to the claiming distributees in accordance with the percentages stated next to the claiming distributees’ names.

12. Any bank, savings and loan institution, credit union or any other like depository, when presented with a copy of this Affidavit of Distribution, shall pay any deposit titled in the name of the from the Decedent, to the claiming distributees in accordance with the percentages stated next to the claiming distributees’ names.

FURTHER AFFIANT SAYETH NAUGHT.

Dated __________________________, 20______.

__________________________________________

Signature of Affiant

STATE OF _____________ }

ss.

County of ______________ }

The foregoing Affidavit of Distribution Pursuant to W.S. § 2-1-201 was subscribed and sworn to before me by ____________________________________, on this ______ day of _______________________, 20______.

Witness my hand and official seal.

Notary Public for the State of _______________

My Commission Expires:

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