HomeMy WebLinkAbout909221AFFIDAVIT
STATE OF WYOMING )
)ss
COUNTY OF LINCOLN )
I, Kirk H. Merritt, 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 Orem, Utah.
That I was well and personally acquainted with Ned H. Merritt and Rhea H. Merritt as
described in that certain Quitclaim Deed dated April 14, 1983 and recorded August 8, 1983 in
Book 203PR on page 871 of the records of the Lincoln County Clerk.
That I know of my own knowledge that Ned H. Merritt in the above described Quitclaim
Deed and mentioned in the attached Certified copy of Certificate of Death are one and the same
person.
That I know of my own knowledge that Rhea H. Merritt in the above described Quitclaim
Deed and mentioned in the attached Certified copy of Certificate of Death are one and the same
person.
This affidavit is intended to terminate the life estate of said Ned H. Merritt and Rhea H.
Merritt in the following described property:
BEGINNING at a point 220 feet North of a point described as 60 rods North of
a point 267 rods East from the Southwest Corner of Section 25, T32N R119W
of the 6th P.M., Lincoln County, Wyoming and running thence West 391 feet;
thence South 71 feet; thence East 175 feet; thence South 16 feet; thence East 216
feet; thence North 87 feet to the point of beginning.
, . /"7-~",
Datedthis /~9 dayofJune, 2005. /J/~///~/~/;
State of Wyoming )
)ss
County of Lincoln )
/( -~ The foregoing instrument was subscribed and sworn to me by Kirk H. Merritt this
day of June, 2005.
Witness my hand and official seal
My Commission Expires: ~.-~
Cl~]tary Public
RECEIVED 6/14/2005 at 4:01 PM
RECEIVING # 909221
BOOK: 588 PAGE: 147
JEANNE WAGNER
LINCOLN t;OUNTY CLERK, KEMMERER, WY
:: .:.::::::::::::.
This is a true and CCtrec( reproduct on.o~ the dCcbment officially registered and placed
on file with the I~AHO B'0REAU OF HEALTH POLICY AND V ~AL STATIST ~S ~<
Th's'cop, is not .val.d Y.less'p,epa~,d ene.graved border-
d sp ay ng s a e sea a~d s gna :re of the Req s rar
~ arried J Rhea Hokanson ,.jdaintenance J
, . ,, ' .,,Hospital
Wyoming
Alton ~ 434 Lincoln '-; _ ~83110
Rhea Mertitt ,, ~ox 1155, AfLon, ~yoming 83110
~UDona~on ~Olher(S~ci~) ' ~ [~' :: J~ :,~ ~":~ ,[. : :,' :
* . . / :,, * . :-;. ,,, :
-'~/~ ~~/..~1U'676 ] Schwab Mortuary. ~:4. EaSt 4th Ave: ',,
..;',:,~ ~../&u.,~ ~,,.J~ .... , .... ~o~o.J: ~J.~¢~j5:2~.'°~ '.': .... .'
' I · ' ' J ' I~ ' g g 'On :': ': ~ Could Not Be Oelermined ~ '
/
No
~_ ..,...,~ _;,,,.~.. :~:. ~ - ~: "q . ' --:- ~: ~: :: .~ v
:Kenneth: ~e1~:-~'~.~/2860 ~hanning .ay: Ydaho FAlls, idaho 8340~
have reviewed an~or amehded, and ~e~ fe~: ~ ' :' '" ,;:': : ' '-' ~ .... J' : '
,.,.,. ,,, ,.. ......... ,, ., .......... ,
VITAL STA~TICS COPY :;: '
~i~/ : ' IDAHO DEPARTMENT OF HEALTH AND WELFARE ,,' ,
~:" ' ~ , ,',, . BUBEAU OF HEALTH POLICY AND VITAL STAT ST CS , ' ';'
, .... / , ,:a[vey. ~i,...... Ned : . Merritt IMale.'.. I%a'tober' t0 '2002
-~OF UTAH - DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
:'- :~_; :'. ' -' "~ ': '? ~- '.";~' "~'/;' ~:~ea-":¢~¢~¢'~?¢~;~4, ME~ Female Febma~ ~3 2005 08'06 '
~:~:~:L~' .'&'.:L:/.~ ..... ~ay ~:.'i:.:..~;;.~.] 1922 ........ 82 ~ ' Grover, WY
:~:~ '.: L?~:? ' ~ ! '~a 't~.~?~.~)'.~;~ ~: . ~ ": Utah Or : '
': . > z.',' ;),~,~. Head C0~k':~' D~i~'~:.:.';;'::" ' Hospital 434 Li ,co~ '
: ?"~T¢~ ~:~: ~ "':77..~ ~";~O~;~;~'~: ;' ;-'.: .':. ~, c~, mw,. co~u.~, o, ,u.~ ~. z, co~, ~ .s ~ c ~ ~ ~s~
PARENTS '~ ' ':~:~.;~:;~'~. '-.-',/;~?';?~:: ~: ~'.;'Z:~';~:~'¢[~<~:::~:~);2:~::(?~2~ :: ' J15, MOTHER S NAME PRIOR TO FIRST ~RR~GE (~t, ~e, Last) . :
S'- :':" :~ ~'' ~':' "~'; ~ ~Juh0us:.A~ur::Hokanson '"': . [ Florence Rachel Hepwonh
,
20:'~ETHOD ~F DISPOSlT ON' ~ ~;~ ~ ~ '-.t~ 21~' ~AT~ OF D SPOSlTION 21b P~CE OF DISPOS T ON (name d
D 2:~i,~. 'D,.a.,.~ . D · ~h :J .~'?;'?Febma~ 28, 2005 A~on Ci~ Cemete~ '
~'I/'$1GN~TgR~0FFU~R~ERVI~"~iC~S~"~L': :'?~; ,:<~tL ~~ .. 8090 South State S~eet ' ' '
':, ~ .~':.:~?~:):~..,~.:..:~,. ~.' :.% '~ ;.<'~; . '~;>'. ~;~: i-
....:;..,..,-:~{~?~:~.%~-, .: ,., .
$)~TU~TJTLEOFC~T~F(E~ ~ UC. NO. 3088050-8905 D~TES~NEO
2~..~M~ ~DRESB AND'Z ~ C~D~ ~ ¢~RS~N WHO GERT ~[ED THE CAUSE OF D~TH ~m 24 ~y~hl) J23b DATE DEC~SED WAS ~ST A~ENDED
~ ~ .... 24.'P~RT I` ~acrmJm ?~~~~'Efiter ~e ~haid of events'-Ui~-~ ~j~ies ~ ~mpli~Uons - that d re,Iv ~used ~e dea~ DO NOT an er ermine even s su~ as cardiac arrest respitato~ j~al~tmate~01nte~
arreal'~ven~i~a[tlo~lalgqTl~[~o~gql~.OONOTABBREVATE ~aronyonecause~a ~e
PART Il. Olhe~ ~ignifimni C~S ~ ~'(G6ahg d'0~A h6u n6 resu ng h ~e ~dedy~g ~use g van n Pan 25a WAS ~ AUTOPSY 25b WERE AUTOPSY F NDJ NGS AVA ~BLE
. ' ';,': ?~:~' ~,;~; ~ ~ ' , PERFORMED? PR OR TO COMPLET ON OF CAUSE OF
26 IN ~OUR OPINION. TQBACg~ U~ ~HE ~ECE~ENT ~< 27. ~NNER OF DEATH 28 F FE~LE
29~.INJURYATWO~? 29d P~CEOF NJURY-A ho~ u~.~m. J29e motorveh~e acddenl: '
29¢ 'LOCATlON ~$tm~t'°r~ "~ ~ ~i~l~ ~F ~t'~b~{~' ~g. DESCRJBE HOW lNJURY OCCURRED (~n ~r ~quen~. ot ~v. nt~ which m~ ~ ~ inj~ ~ TURE OF I~JURY ~hou~ ~e :
~ ...... :~5~..¢ ~z,;.~% ;~; ~/, . ~. m. ~,. d,~,s th~ ~'~.~t ~,, ~ .
33 REGISTR~'8 ~IGNATURE ~.L~;~ ~-~.~..~?; ':. 34. DATE '
. This iS to Certi
Date iSSued:`
County '.
n thi~, office. This certified copy ~s issued
353 AS Amended.
, E. Nangle
)IRECTOR OF VITAL RECORDS
*01639345,