HomeMy WebLinkAbout909973.00!64
WHEN RECORDED MAIL TO:
McKay Marsden, Esq.
8 East Broadway, Suite 414
Salt Lake City, Utah 84111
RECEIVED 7/14/2005 at 4:27 PM
RECEIVING # 909973
BOOK: 591 PAGE: 164
JEANNE WAC- NER
LINCOLN COUNTY CLERK KEMMERER, WY
AFFIDAVIT - DEATH OF JOINT TENANT
STATE OF WYOMING )
): ss
COUNTY OF SWEETWATER )
That Patricia E. Anselmi, of legal age, being first duly sworn, deposes and says:
Dated:
The attached certificate of death is the same person as Paul D. Anselmi
named as one of the parties in that certain Quitclaim Deed dated June 1, 1984,
vesting title in Paul D. Anselmi and Patricia E. Anselmi, recorded on June 6,
1984, in Book 214PR, Page 312, of the official~'ecords of Lincoln County,
Wyoming, for that certain property des~ the attached Exhibit A.
Patricia E. Anselmi
Subscribed and sworn to before me, the undersigned Notary Public this /1 day of July, 2005,
by Patricia E. Ansehni.
Public
~, d~ ~ *T1BL',.'~ ,P ;.? ,~;'
EXHIBIT A
LEGAL DESCRIPTION
O0165
a diskanca of 6i8,44 ~ee't~ to khe point of curvature
are o: said curva ko tho le~r through a c~mtr'al at:~qle
~eet, ~mi,/l point o~ range:ney alSO being th~ [mink of
BL,,,CK
FOR
INSTRUCTIONS
SEE
HANDBOOK
LOCAL FILE NUMBER
DECEDENI- NA~dE F~s'r
MIDDLE
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
PAUL DAVID
4 SOCIAL SECURITY NUMBER ~l. AGE-L,~al Birthday
(YeenU
520-36-0041 63
7t PLACE OF DEATH (Check c~dy one}
~SP~TA~
O0!GG
STATE FILE NUMBER
L-4~T 2.SEX 13. DATEOFC~ATH (Mo., Day, Yrj
ANSELMI Male July 5, 1998
Sb. UNDER 1 YEAR 5c. UNDER 1 DAY I e DATE OF I~RTH (A6o., Day. Yr.)
~,,~ ~ ~ ~ra, November l l, 1934
r-IIn~atle~! l~ER/Ou~tidn! [-)DOA IOTHER: f'lNur~lngHc~'ne l--]Refi~e~ce
7b. FACIUTY NAblE (ff r~t hsSa~on, give slm~t r,d t~/nb~)
Memorial Hospital of Sweetwater County
8 STATE OF BIRTH Iff not ~ U.S.A.,
Wyoming
13. WAS DECEDENT EVER IN U.S. ARMED FORCES?
fSpeci~r ye~ o*' no/
No
1,la. RESIDENCE - STATE 113b. COUNTY
I
.Wyoming
13e. INSIDE CITY UUITS?
fs,~:~./ty y~ or no)
Yes
7. FATHER'S NAME FLI~
John
INFORMANT.NAME (Type or Pr~XJ
I Tc. CITY, TC~VN, OR LOCATION O~ DEATH J7d. COUNTY OF DEATH
Rock Springs I Sweetwater
9. MARRieD. NEVER Id,U:IRIED. [ 10. SURVIVING SPOUSE f# wile, g~e malk~en name)
Married I Patricia Tomsik
12&. U~UAL OCCUPATION~(fivewark/~g/°h°* //f,,°f wOrkevendcvle/t m~md)~'/ng mo~ 12b. KIND OF BUSINESS OR INDUSTRY
Chief Executive Officer Banking
13C. c~rY, TOWN OR LOCATION
Springs
Sweetwater Rock
114' (Soedfy i~ or y~I -# ye~. ~ly
Cuban, Mexlc.~. Pu~to Rican. Etc.)
134 STREET AND NUMBER
1727 Collins Street
WAS DECEDENT OF HISI:~Ah'IC ORIGIN?
No'~ Yes [] b-~fy)
Middle
15. RACE -American Indian. ! 6. DECF-D~'S EDITION
B~O,.. ~, E~
White m 12 / 4
18. ~THER'S
Lilja Malmberg
Mrs. Patricia Anselmi
I Ob. RELATIONS&lIp TODECEDENT
Wife
19c. MAIUNG ADDRESS STREET OR RF.D. NUMBER CiTY OR TOWN STARE ZJP CODE
1727 Collins Street Rock Springs, Wyoming 82901
2Oi. Bud~L C~m~lion, R~'nov~ 20b. DATE (k~o., D~, Yr.)
~ State, Othe (~oecify) I '
Cremation I_ Jul. 5, 1998
2 l&. FUNERAL SE,EIYfCE UCENSEE O/~, .;~.'~ Acting Numberl2 lb. NAME OF FACIU'rY
~as,?',. ) ,-/
' ....... 380 I
L
20c. CEMETERY OR CREMATORY-NAME 2Od. LOCATION CITY OR TOWN ETAT~
White Mountain Crematory Rock Springs, Wyoming
Number 21C RE F ILITY
I l~J~ ~1~ ~treet
Vase Funeral Home 85 } Rock Springs, Wyoming
2t 'To th~ be~ o4 E~ Imowledge. ~eath ~r~ mi t~ ~. ~le a~ p~ ~ ~
~ ~ (~. ~, W.J ' ' 22~ H~R OF D~TH '
July 5, 1998 5:03 A M
22d. N~E OF A~N~NG ~lC~ IF OTHER T~N CE~IFIER ~ ~ ~)
24. NAME AND ADDRESS OF CERTIFIER (PHYS, IC~AN OR CORONER)(Type or Prk'4]
"" '~' "'* '~ ~' ~ ~' ~' =.--I~ ,"ya/q / uoroher
23b. DATE ~NED (M~. ~, YrJ ~ HOUR OF DEA~ '
July 5, 1998 ~ 5:03 A M
2~. PR~NCED ~D t~.. ~. ~J I~. P~N~D ~ I~)
July 5, 1998 ~ 5:03 A ~
Thane Micha~C'lxMains, M.D., MemorialtHospital of Sweetwater
~\ /~ .., / County, Rock Springs, Wyoming 82901
25~. REGI~R
YrJ
...... ~ ~ ~ ~. ,~. ~ .,. .... .~ ,-. ',.~
~ME~ CAUSE (~ I I1~ ~ ~lh.
~E ~ (~ ~ A ~QUENCE OF}:
1
No ~ Yes
VR 2-89
8/97 15M
bL&NNER OF DEATH 3C~. DATE OF INJURy 3Ob. TIME Of'30c. INJURY AT WORK? 30~. DESCRIBE HOW INJURY OCCURRED
: I--J (IW~Xh, De.y. Y,] I'%IURY (~oec#y )~s or no)
Na~ur~LJ Pending
~ M
3De. PL.ACE OF INJURY-At home. latin, ItreeL flctory. ~0/. LOCATION (Street and Number o,'
~ Could no( be ~lice b.~ding, e*,c. {Spe~] Rurl~ Route Number. C~ ~r Town. b~at
Ho~nldbe
DATE ISSUED July 11, 2005
THIS IS TO CERTIFY THAT this is a true correct conformed reproduction of the original
copy of the dea~:h certificate completed by the VASE FUNERAL HOME and submitted
ORDS SERVICES, Wyoming Department of Health and Social Services,
Services at Cheyenne, Wyoming.
STATE OF WYOMING)ss
COUNTY OF SWEETWATER
Subscribed and sworn to before me a Notary Public
this llth day of July 2005
My commission expires on April 21~ 2006