HomeMy WebLinkAbout909463AFFIDAVIT ESTABLISHING SURVIVORSHIP
OF JOINT TENANT
Patricia J. Burnside aka Pat Burnside, being first duly sworn, deposes and says:
1. This Affidavit is given, pursuant to Sections 2-9-102 and 2-9-103 Wyoming
Statutes 1977, as amended, to establish the survivorship rights of the surviving wife and
to establish prima facie evidence that all facts recited herein are true for the purpose of
such legal effect as may result therefrom by operation of law, pursuant to Sections 2-9-
102 and 2-9-103 Wyoming Statutes (1977) as amended.
2. A Warranty Deed was entered into on May 27, 2003 and recorded in Book
522PR, page 145 h~ the Office of the Lincoln County Clerk in Kemmerer, Wyoming,
evidencing ownership by Glade Burnside and Pat Burnside, husband and wife as
tenants by the entireties (joint tenants) of the following described property, namely;
Lot 1 of Good Neighbor Subdivision, according to that plat
recorded in the office of the Lincoln County Clerk on March 14,
2003 as Plat No. 131-C.
3. Glade Bttrnside died on the 17th day of March, 2005 and his death was
duly registered as evidenced by the certified copy of the Death Certificate attached
hereto.
DATED this
day of June, 2005.
, ' ' J. ' ' Pat Burnside
STATE OF ~-/)/~/4 0 )
)
COUNTY OF )
RECEIVED 6/23/2005 at 10:59 AM
RECEIVING # 909463,
BOOK: 589 PAGE: 209
JP:ANNE WAGNER
LINCOLNCOU qTY CLERK, KEMMERER, WY
The foregoing instrument was subscribed and sworn to before me this ~/)e°
day of June, 2005 by Patricia J. Burnside aka Pat Burnside, who does verify that the
foregoing statements are true and correct to the best of her knowledge.
WITNESS my hand and officitq seal.
Notary Public - ' TM F'
My Commission expires:
STAT.E OF WYOMING
DEPARTMENT OF HEALTH ,.
::: .. i !i '::::! " ST*TEOFW OM,.G
:"' DEPARTMENT OF HEALTH ':"' '"
LOC~ riLE ~UMBER CERTIFICATE OF DEATH ST^~E riLE
:::. iFDEA'i;HOCC~R.EDJNA;40~PIT^t.::: i:~ I~E~H~cu~R~'$O~EW~[fl~IHES/~A~O$~T~::~:'-: : :' :. , :: '' .? ''..' : ~.:' :~::.
m~ 448 GOOD'NEIgHBOR LANE ',~:,L, :, ,:.~ ':.' -~;,::.:' /.: :.:ET. NA~,:' '"¥:.c "' '" . ' LINCOLN
~ i' :.v · :: · ' ~':':~" ' :?~:'~Du~;,.~' ~:~':~'~;~'~u,,~,.[.~""~D:~:'%:t:~ ::::' :" '.:': ' ::?:'-'" ' :. ....... ':
~ . .DR~OOS~ ~DAHO ..... ~'v · ......... , .... ~ ....... ~. ..... : .......
~ ~ ~ Evi~l~u,s. . ..,i2~ RESID~<E :~t~T~".~,~'j ";~ .... :~' :~ ::~ CO~' ' i~ ~;~';~ ~' L'~TM 'I2¢.~T~0~'LOCATJO~: . ~ · '
· ~ ~.., '~._:'-~"1~ :~ou~e":?..-~'~' t, ",.-:'~- :~ -~z~co~'~..~.': ~' ~'%~. "~-~¥-'.,~'." ::~,' - ..... ·
~. ~ .".. ::" ' ," - "' w':; :'" ';~ '" ..... ' '"' ' '""' ' -,"" ":" ] '," ~>' ~":. :1 · "q'""'" : .... '"
~,~ ' F"': ,~-":N ' ,:.~ ;-' ELDA~..~CAS~ER ..~ ..... '~'~ ;/~,:;,~:,' ..'.% ',
' ,t:~;2~O00~'.~,. ~. .... ~;~ '.t.:,~.~CH 1 ~, ~'2005. ,' ' .... .~, ~ '~O~0 ' ~ '.'" 7 '~ ~';i:~ '-'~,--'~
.... ' .," ."~. ,..~. ~':'~ ~: , , -~CAUSE OFDEATH .................. ~. :'.v ."~ "~ ..... .., ~'~ ~,: ) ' '"~ ;' · :'.
' -"/ ':r'"?~'~:':~'>:~.'~;.%~.~'t= v ~-,~r,~ .,~. ~.:~:; ~ ,~.'~,~ ,~:~;..':..,~:1~ ~ ..... : :.:
.. ..~n~.~a~..~s~)~.t ' ~: ',~'~, ~,,.,::~C:"H' ~.. :i~-~....' '::'~ ~;."~';' : '": ."?j.Z~'~'~:::~;::~';~':~t:~...' ¢/ : '~: '::' '. '.:'
· ..:.:,.. :.:.,~, .,~_. ,~:..~c.~~.:: '~'~ ,. ,.,.,7. ~'~:~ ~- ':"1 ~~
~:: ...... ~ .... . - ...... ~ ,,,~-t, ...--~,:. ~,/,.,* .... ~ .' .
e ~ ". Du~P,.,~.,.,n~;.,~.., """ D~.p,.~.~;~3'~X,~(~..r~,..~,~. ' : ' ": ~.;~,., ._' ':"' "'OH.~ . ' .......
.. '- :. ... /'D~i~(l~ :, ~.. ~ ' ·
, ..:" ':: ':'::'"' ::~ ' '~:~ :"~::' :~::: :" · '::~: ': ."' ':h ' ':?: "~' [:.~ ~P~..t,~' ::: .::"'"':::~. D~;l~p..,~i'-':' · ":: ":~"~':~ ':'::
:,: . ?. ~;:.~~~- .. ~:.. ...~~~:. . .... ~~': ~:. ~ ~' . :i' ~::~, . .~ :.' ~ :~.
?"2 -:~)::~ '~;~:':~' ': '"~M~HAE~ ':R'. :~RICHINS ~ORONER .P¥'~O. :::BOX '5:7 ';~'OROeER:j~.' '83:~ 22~T'/'::~:::'
This is a trbe and exact reoroduction o[ me aocumen[ on file in the office of ~/l[al
" "!::':.; Lu'cir~aMcC~ffreY'i;~/:i!:::t :.:::::!i
· . i:. Depuly S ate Registrar !!.
~ is-nol v~lid unless prcparc~ on paper with an cnsravcd border display ng thc date, seal an~l signature or the Dcpuly State Ecgis rat