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HomeMy WebLinkAbout909812STATE OF ::: ':!ii RECEIVED 7/8/2005 at 2:34 PM RECEIVING # 909812 BOOK: 590 PAGE: 492 Jl -'ANNE WAGNER LINCOLN.__ COU XlTY CLERK, KEMMERER, WY /~y(,,M/] i ~ AFFIDAVIT OF SURVIVING SPOUSE COUNTY ~ }(I~[P'~ OR JOINT SURVIVOR "~ ,. DONALD RUDDY deposes and says as follows: , being first duly sworn, 1 ) That DONALD D. RUDDY and SANDRA L. RUDDY are joint owners of property under a duly recorded survivorship or tenancy by entireties deed. 2) That the property is known as 1023 3RD WEST AVENUE __ KEMMERER , Street and City __ Lincoln County, State of WY and also known as Permanent Parcel Number __ 21162311115100 __ on the records of the County Auditor. The original Sm-vivorship Deed is recorded in the records of the Lincoln __ County Recorder in Volume __ 529 , Page __ 830 I have included the descriptive infom~ation requested below and have attached a full legal description as an attachment hereto. "SEE EXItlBIT "A" ATTACHED" 3) That __ SANDRA LOUISE RUDDY I died on or about __February 13 , 2005 , at 3am 4) That by virtue of the death of the party listed in Item #3 above, DONALD D. RUDDY is the fee simple owner of the above described property and requests that this fact be reflected on the land and tax records of the county. Witness Affiant Witness Affiant STATEOF i~l/~)~d(Y[_,~( COUNTY OF Sworn to before me and subscribed in my presence this 20 dayof Notary ~pblic My Co~mission Expires: ,- 0c04 STATE /'~ r'~ 1 A I%/'/"%, R J! I & I/-,k, ::':; ~r:~ ~ O DEPARTMENT OF HEALT:H" q~:~'i'rd Awe:,, 5~.:~D~':: ':~: S&T~o,w,o%~: ' .: . .: 2 0 0 5-0.0 0.~ 5 I ' L~AL FILE NUMBER 1005 ~{. O~p{, CERTIFICATE OF DEATH STATE FILE NUMBER ':::~ "'{ : i - · : '" , 1~.'~[~1~:~I '..::., :> :::: iFDEAm~C~RREDtNAItO~ITAL.:.~ ~[] IF'DEAt)~Cg~ED~U~WHEm:~THERT~A~O~IT~~ '~:. .~:~ ~:~ .' ::: · ~: : :. " Residence - 1023 3rd West Avenue' ',?; 5:>-1. ,5, . . . Ke~erer'': ' / I Lincoln~ "~,,,, ,~; . ,, . ( ~ ' ' T ~[ ."' .~., .,; , 4; , ~.J :':.,: :& oonaAQ ougan ~UQGy . : ' ~ ~'~ . ~ ~: · , .... ' .... K..' C~.'~ ..~ .. . ~ Edward Carl auhnie ~ :-:5.'' '" ' .' Do?0~hi~' Luana Davis :. · ~~ ~ [ '464::.'-'PandilI::: Funeral. HBO, iii: 9i5 Pin':Ave:. Kg~&rer,~ : ".. '..: · 5 h .: ~ .? ': .... : 5~ , :::'.~,',,-¢:~::: ~s' ':~'>~: :' : ~:; ~ 77 ~ :: · .: ., ..,:..:. : .. ,> - , CAUSE OF DEATH .... · .... -,. -.-'r..,/. ::;=~,' ':':"" ' ,~ :' ' i i ~ ~ .:': ' :' :': '.. '::-: 5: ',? ":.: "::::' 5:?('" :::::~ ~ ::?"'"':.' :'" '"'::.. ':::'" ::. 'X ' :.' · O ::.....: :: ': .. .~:., .. :::~. .:. :'::i:' %..,.;? ~g~. :......:' ::t .... ~ / - ~PHYS~--lo~it0lmy~,~ama~rfidat~/~ale~pt~i,~u~iJ~m~l ~a~ .... , ....... .... ' :' ~ebrU~y ~,:: 2005 [ ~ri:::'O~ry No~::, 197 ?orth.:~ln~: ~a~:;"-:~y~mlng 829B7 ::"February 17~' 2005 This is a 'true cna exact reproduction of the document on fde in the office of Vdal ~" Records Semi,es cheyenne, Wyoming. :: ..... DATE ISSUED: :FEB ~3 2005:.. : ::i '::i: 'i i. .... Luci~daMcCgfrey // Deputy State Reg strar is not valid unless prepared on seal and sign~l>!(e o{the Deputy State R~gistrar