HomeMy WebLinkAbout908942 RECEIVED 613/2005 at 1:59 PM
RECEIVING # 908942
E OOK: 587 PAGE: 200 JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0 .VO
AFFIDAVIT
STATE OF WYOMING )
)ss
COUNTY OF LINCOLN )
I, Derrell Suter, being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America and over the age of 21 years, and
a resident of Bedford, Wyoming.
That I was well and personally acquainted with Sam Suter, Jr. and Delores Suter as
described in that certain Warranty Deed dated January 1, 1982 and recorded April 14, 1982 in
Book 186PR on page 430 of the records of the Lincoln County Clerk.
That I know of my own knowledge that Sam Suter, Jr. in the above described Warranty
Deed and mentioned in the attached Certified copy of Certificate of Death was one and the same
person.
That I know of my own knowledge that Delores Suter in the above described Warranty
Deed and mentioned in the attached Certified copy of Certificate of Death was one and the same
person.
This affidavit is intended to terminate the life estate of said Sam Suter, Jr. and Delores
Suter in the following described property:
S~ANE~,~, NE¼SE¼, Lots 1 and 2 of Section 3, T33N Rll8W of the 6th P.M.
Lincoln County, Wyoming. '
Dated this
day of June, 2005.
STATE OF WYOMING )
)ss
COUNTY OF LINCOLN )
errell Suter
Derrell Suter, being first duly sworn upon my oath deposes and states: That I am the
Affiant in the above entitled matter; that I have read the above foregoing Affidavit by me
subscribed; that I know the contents thereof and verily believe the statements therein contained
are true.
Derrell Surer
The foregoing instrument was subscribed and sworn to me by Derrell Surer this ~day
of June, 2005.
Witness my hand and official seal.
My Commission Expires:
Notary Public
LO~AJ. FiLE NUMEER
MIDDLE
STATE OF WYOMING
D~3$1ON OF HEALTH AND MEI~ICAL SERVICES
CERTIFICATE OF DEATH
,.- 00201
STATE FiLE NUMBER
LAST ! SEX Il tJDATE OF DEATH
iN Samuel Rudolph Suter I May 16 1984
PER~,ANERT ~. 2 Male 3.
s~ ~,. White' Ih~~'' Swiss ~' 70 ~ ' ............. Dec 2,1907
H~D~OOK · ~. [ 5c. 6.
;,. Residence ,~1 Bedford
Lincoln
,~o~,, Delores Rickenbach
~o,~ ~. Switz erla . U. S.A. ~o. ~arried
,$~,~,~7~t~ ~ 520-~2-25~5 . Rancher ~ ~~ '
15~. 15c 15d 192
~. Samuel Rudol~h Suter 1~ Kathern Kerf er
~'NFOR~E '~v~ ~r ~rm,, I M~L'"G ADDRESS STRE~ OR R.F.D NO.
CITY
~~~,,. Delores Sutter , 'J~,~ Box 192 Bedford Wyoraing 83112
~, Burial ~,~May 19,19~, Bedford Cemetery Bedford Wyoming
I ' ' ll,d.
k'~.-/ ~ &~~ ~,~~'~ _Schwab Mortuary ~z0~ Ar¢o~ W~om~
21a.~o~ot~Knowmeoge. Ceath~urr~at~m~pla~a~etome 22a. On,heoasso e~amna,onan~o~ve~t~-~on nm o
~ ~ NAME6FA~ENDI~PHYSlCIAN~OTHERTHANC~RT~FIERCT.,.~orP~n~, ~ / ~0 ~RONOUNCEDDEADfMo Da Y
2~d. 22d. 0N 22e. AT ~.~
23. O.D. Perkes~bl.D. Star Valley Hospital, Afton, ~oming 83110 '
~TATING THE
26. 27
28a. ] 28L . .
Date Issued
Hay 31, 1984
THIS IS TO CERTIFY that this reproduction is a true copy of a record on file in
Vital Records Services, Division of Health and Medical Services, Wyoming Department
of Health and Social Services, Cheyenne, Wyoming.
If this copy does not bear a raised sea] and the signature of the Deputy State
Registrar is not in RED, 'this is not an official?e~ified/ copy.
Lawrence J. Cohen, M.D. ' ~ Richard O. Hal]'~ ' .
State Registrar \ Deputy Sta~e Registrar
I~iEALT
COOPERATIVE CENTER FOR
HEALTH STATISTICS - VITAL
STATISTICS
DATE FILED: MARCH 09, 1992
DECEDENT: DELORES ELISE SUTER
DATE 'OF DEATH: MAR. 02, 1992
DATE OF BIRTH: MAY 22, 1916
AGE: 75 YEARS SEX: FEMALE
MARITAL STATUS: WIDOWED
SOCIAL SECURITY NUMBER: 520-60-1621
FATHER: ALBERT RICHENBACH
FATHER'S BIRTHPLACE: SWITZERLAND
MOTHER (MAIDEN): BERTHA SCHWIRZER
MOTHER'S BIRTHPLACE: SWITZERLAND
MORTUARY: WOOD FUNERAL HOME
MORTICIAN: RALPH M. WOOD
CERTIFYING PHYSICIAN: JILL M. RIEGEL, MD
1. CAUSE OF DEATH, UNDERLYING CAUSE LAST:
STROKE
CORONARY ARTERY DISEASE
END STAGE PULMONARY FIBROSIS
450 W. STATE ST.
BOISE, IDAHO 83720
CERTIFICATE OF DEATH
STATE FILE NUMBER: 92-01222
PLACE OF DEATH: IDAHO FALLS, IDAHO
PLACE OF BIRTH: WYOMING
VETERAN? NO
RESIDENCE: BEDFORD, WYOMING
IDAHO FALLS, IDAHO
DISPOSITION: REMOVAL
AUTOPSY: NO
INTERVAL
12 HOURS
MANY YEARS
MANY YEARS
2. OTHER CONDITIONS CONTRIBUTING TO DEATH BUT UNRELATED TO ABOVE CAUSES:
NONE LISTED
DATE ISSUED: MARCH 26, 1992
This ~ to certify that th~ is a true and correct reproduction or abstract of the official record
filed with the Idaho Department of Health & Welfare, Boise, Idaho.
RICHARD W. BLAIR, State Registrar
DO NOT ACCEPT UNLESS ON SECURITY PAPER WITH EMBOSSED SEAL OF IDAHO
DEPT. OF H~ALTH & WELFARE CLEARLY AFFIXED.
Section 39-273. Idaho Code