HomeMy WebLinkAbout910767;/00818
AFFIDAVIT OF SURVIVORSHIP
STATE OF ORE~ON )
) ss.
COUNTY OF ~ )
RECEIVED 8/9/2005 at 3:55 PM
RECEIVING # 910767
BOOK: 593 PAGE: 818
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, VVY
I, JUDY M. IOTT, being duly sworn under oath, state as follows:
1. Kenneth Lon Io'tt has tenancy' by the entireties with me in land in Lincoln County,
Wyoming, more particularly described as follows:
Lots 1, 2, 3, 4, and 5of the Alton Mini Mall Addition to the Town of A_fnton,
Lincoln County, Wyoming, as described on the official plat lhereof.
Attached hereto is a copy of the Warranty Deed creating the tenm~cy by the entireties, recorded
in the Lincoln County, Wyoming, land records in Book 159 PR at Page 885, on September 10,
1979, as Instrument No. 529944.
2. I, Judy M. Iott, the surviving spouse of Kenneth Lon Iott, hereby certify that
Kermeth Lon Iott died on November 7, 1999. Attached hereto is an original copy of the
Cert~cate of Death issued for Kermeth Lon Iott.
3. Pursuant to Wyoming Statutes {~ 2-9-102, I certify that the tenancy of Kenneth
Lon Iott has been terminated by his death, and that title to the above-referenced lands are now in
the name of Judy M. Iott, a single woman.
DATED this 1st day of August, 2005.
ACKNOWLEDGED, SUBSCRIBED AND SWORN TO before me by JUDY M.
IOTT this 1st day of Aug~tst, 2005,
/ , / NOTARY PUBLIC
I ~ COMMIS..qON NO. 35225.5
~ MY COMMISSION EXP1RES DECEMBER 19, 2005
FOR
INSTRUCTIONS
SEE
HANDBOOK
LOCAL FILE NUMBER
DEC~DENT- NAME F~RST
KENNETH
STATE OF WYOMING
DEPARTMENT OF HEALTH
561-52-1590
?a. PLACE OF DEATH (Check ~ one)
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
STATE FILE NUMBER
LON IOTT Male November 7, 1999
58 Februar7 2, 19/+1
Oregon
No
DONALD
Judy Iott:/
.OSmT~ __ -- __ Imam: _ _ ___ Border of Teton Natl Forest & Yellow-
F~ WE (~ w ~u~ ~4 ,~ ~ ~ :' :~:': .::: ':.. 17c. ~, ~. ~R~A~ON ~ DEATH / 7d. C~N~ OF D~TH
Junction of Wolverine Creek&J6nctiofi'=:C?e~-- Bridger Teton Natl F°res~' Teton
w,~0, o~c~e~j }u y:' Scgtt
California '~rried d :
..~SBECE~NT~ER~UaAR~ED~ORCES? Real Estate Broker Prudential
~. c~. ~N OR L~TeN ~ STRE~ A~D NU~ER
13~N~ IDalias 115950 Highway 22
VIRGIL IOTT ~TH_.'S NAVA MODE~ HIGHFILL
1~950 H~ghway 22 Dallas Oregon 97338
t2ob' DATE/~' ~' Y,') DX las'
alt Creek:Cemetery
November S 1 Ore gon
Valley M~rtuary ? 119 ::1 950:'~lpi=:e Lane; Jackson.k~
'~ m November: 7/ 1999 I 10:00 .A u
~obert Campbe11, Co~one~ ~.0. ~ox 2099 3ackso~, ~ 83001
,.~,~ ~ ~m) w · Cardiac Arrest
~, Arteriosclerotic Heart Disease
VR 2-89
4/94 15M
25b. DA~E RECE~.~) BY FI~[I~iISTRA~ (MO.,
)nSnutes
~Years
27. AUTOPSY ($peclft28. WAS CASE REFERRED TO CORONER
No Yes
29 MANNER OF DEATH 30L DATE OF INJURy3Ob. TlblE ~ 3Oc. INJURY AT WORK? 3Od. DESCRIBE Howl INJURy OCCDRRED
071587
This is a true aha exsc[ reproduction of the documem on file in the office of Vital
Records Services Cheyenne, Wyomin§.
DATE ISSUED: DFC - 6 1~}99
is not valid unless prepared on paper with
Lucinda McCaffrey' ~
Deputy State Registral
and signature of thc Deputy State Registrar