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STATE OF WYOMING
COUNTY OF LINCOLN
AFFIDAVIT
NOTICE FOR PUBLIC RECORD
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RECEIVED 7/22/2005 at 10:44 AM
RECEIVING # 910195
BOOK: 591 PAGE: 870
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
I, FRANK DANA and ANNA K. ERICKSON, being first duly sworn, on oath depose
and say:
Wyoming.
2.
That we are a surviving children of Fonda Dana of Thayne, Lincoln County,
That Fonda Dana died in the County of Lincoln, State of Wyoming on January 8,
2001, as evidence by a certified copy of the death certificate attached hereto.
3. That the decedent is the same Fonda Dana, named as Mortgagee in the Mortgage
Deed with Release of Homestead recorded under Recorder's Instrument No 491561, Book
135PR Page 171, in the records of Lincoln County Clerk, Lincoln County, Wyoming and the
Mortgagee in the Mortgage Deed with Release of Homestead under Instrument No. 491559,
Book 135 PR Page 168, the records of Lincoln County Clerk of Lincoln County, Wyoming.
5. The decedent is survived by the following persons, so far as ~known or is
ascertainable:
Joyce Ford
12441 North 5th West
Idaho Falls, ID 83401
Carolyn Johnson
922 Dennis Circle
Idaho Fall, ID 83401-5606
Frank H. Dana
1040 Muddy String Lane
Thayne, WY 83127
Anna K. Erickson
412 Muddy String Lane
Thayne, WY 83127
Joan D. Jensen
71 Grover Park City Road 172
Grover, WY 83122
Jim Derricott
3849 Hartland Circle
Idaho Falls, ID 83406
Dana/Erickson Affidavit Page 1 of 2
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Kim J. Derricott
13600 Havelock Trial
Apple Valley, MN 55124
Lori Baird
1478 East 1000 South
Pleasant Grove, UT 84602
FURTHER, THE AFFIANTS SAYETH NOT.
DATED this ~ ~ day of June, 2005.
F'tS,_ANK H DANA ..~.~A ~,,
ANNA K. ERICKSON
THE STATE OF WYOMiNG )
)SS.
COUNTY OF LINCOLN )
Frank H. Dana and Am~a K. Erickson, being first duly sworn according to law, deposes and
states: That they are the affiants in the above entitled action; that they have read the above by
them subscribed; that they know the contents thereof~ believe the statements tl3~ein
c onta i ne d are tr us.
FRANK H. DANA
Witness my hand and official seal.
SUBSCRIBED AND SWORN to be fore me this
My Commission Expires: C/-..,~3 -Oq
ANNA K. ERICKSON
<Vd-/--O day of June, 2005.
NOTARY PUBLIC
Dana/Erickson Affidavit Page 2 of 2
INSTR~$
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STATE:~: O F'.~?WYO M I N:G
FONDA
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OEPARTME'NT OF HEALTH
STATE OF WYOMING
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CERTIFICATE OFDEATH st^t~ ~a
DA%A '::~ ~:~" ~F~LE ~'JA~A~'~',~'O1
4 ..... :- : : .: ' :': ' - SEPTEMBER 26, 1916
STAR VALLEY MEDICAL CENTER
WYOMING
WYOMING
NO
WIDOWED,
:. LO..RENZ0
THAYNE
WHITE
HOMEMAKING
iO08'MUDDY STRING ROAD
WYOMING
BOX'i42 : :~ :::
KATIE ~ 'k CARPENTER
VR 2-89
11/99 15M
:44 .EAST FOURTH AVE., AFTON
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