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Home My WebLink About910772THE STATE OF WYOMING ) ) THE COUNTY OF LINCOLN ) SS. .0O825 RECEIVED 8/9/2005 at 3:58 PM RECEIVING # 910772 BOOK: 593 PAGE: 825 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY AFFIDAVIT TERMINATING ESTATE BY THE ENTIRETIES I, Lillian Juvan, being of lawful age and first duly sworn according to law, upon my oath, depose and state: That I am of adult age, a resident of Lincoln County, Wyoming, and the Affiant herein. That by virtue of the conveyance which is recorded in the office of the County Clerk for Lincoln County, Wyoming, located at Kemmerer, Wyoming in Book 50PR on page 537 is recorded a Warranty Deed. The Warranty Deed, dated the 9th day of September, 1961 conveys unto William C. Juvan and Lillian Juvan, as Husband and Wife as Tenants by the Entireties the following described property, to-wit: Lot 8 of Block 25 of the First Addition to the Town of Kemmerer, Lincoln County, Wyoming as described on the official plat thereof. That by virtue of the conveyance which is recorded in the office of the County Clerk for Lincoln County, Wyoming, located at Kemmerer, Wyoming in Book 101 PR on page 32 is recorded a Warranty Deed. The Warranty Deed, dated the 2nd day of June, 1972 conveys unto William Charles Juvan and Lillian Juvan, as Husband and Wife as Tenants by the Entireties the following described property, to-wit: Lot 14 of Block 4 of the Lincoln Heights Subdivision to the Town of Kemmerer, Lincoln County, Wyoming as described on the official plat thereof. That said William C. Juvan aka William Charles Juvan died on the 16th day of March, 2005, and a copy of the original certificate of death, certified to as true an correct by public authority in which the original of said certificate is a matter of record, is attached hereto as Exhibit "A". That by reason of death of said William C. Juvan and by reason of §2-9- 102 W.S. (1980), the decedents interest and title in said conveyance has terminated and title to the real property conveyed thereby has vested absolutely in Lillian Juvan continuously since the death of the said decedent. FURTHER AFFIANT SAYETH NOT. Dated: /.,/ Lillian Juvan 00826 State of Wyoming County of Lincoln h~Tlu~ foregoing instrument was subscribed and sworn to me by Lillian Juvan this day of August, 2005 Witness my hand and official seal. My Commission Expires' Notary Public Commission Expire~ ~ ~ ~_~-Z)--~'''j_ _t .~ALE,L...M.E. ,TE OF DEATH · ,DECEDENT'S LEGALNAME(nclude~AKA'$ f~ny)(First Middle Last) 2 SEX 3a DATE OFDEATH/Mo Day Yr) 3b ' , .-;~'~J",-,~i' ' ...... - - 0 O TH [~iZ.Z~;,^TEO~,i~lml¢~io~'~,;i e~a~z~lescf~:": Juvan . Male March 16, 2005 12:24:. Feb. 23r ,1930/I;,!:~?~75..~:, Sublette, Wyoming 520-24-5264 ~ :"~::~i¢~':~: ~'~;,"~ ~: ~'"' · LACEOFDF..ATHfCheckonly~ne) IF OEA3~I OCCURRED IN A HOSPITAL~.;~ ~ ~'; '~//"~ .' IF. DEATH OCCURRED SOMEWHERE OTHER THAN A HOSPITAL: ~] 1. Inpatieni [] 2 ERJoutPaue~lt; ~]'~!~ '~-i';:~ 5 Nuffa og HOme/Long arm care faci i~y [] 6 Decedent s Home [] 7 Other (spedfy) ~Ueet. eddress ofloce#on) . :.?:~ }~'~':~: ~'? { ~:~:~ . .... TION OF DEATH · · "'LDS:;:';'H:~sPi~Ai':: .: I Salt Lake I Salt Lake City : 12a. DECEDEN~"SUSU~LOCCuPA~ON£qNe~hd~fworkI12b. KIND OF BUSINES$ OR iNDUSTRY 31 7 Pine Ave. ' · . Tipple oper::a~fli.~.~iii~:~Coai Mining 13~.STATE !3~;C,O..?T~ ~(~.!. · 13~cm¢ TOWN, COMMUNITY OR RURAL ~3e. ZIP CODe ~3[ ~NS~OEClTY UMITS? ~ : Wyoming '~i;(:J{' %~{~f~!!~.:.i?i:!{ .:'! Kemmerer 831 01 ~ ~.¥e, [] ~.~ ' $4'FA~HER'SNAME(FI~'Middl"I~);~:~J~"'~ ~ ~' " Antonia Marchak PAR~TE' charles. Wi!li{~3~'~?~ ~:: :/~ :. 'S. MOT~ER'S ~UE"mORTO FIRST ~R~S~ (S~,t. ~,,. '"FORM*~T nillian ~'~(~'~)~:;~3i~ Pine Ave. Kemmerer, Wyoming 83101, ~.~ ~..~,~,~.~;~,~;~..~,~a~ch 21 ~ 2005 ~emme~e~ Cemetery ~ 17- M~OD OF D~u~II iuN ' :; ;? ~ }i 8a~ D~ OF DISpOS ~ON : Kemmer er.~ ~: W~.~m~ih~ '. ~ ~ ,~: ' : ~.. g.::,.'. ~ 115198 Crandall Funeral Home ' ~'S'e~TU~OF~UN~S~"Y~UC~EU' 105 E Center St ....." Kamas~ Utah 8403~ ' : ~ 2'~ On~ ~;~;x~an~orl~e~gatl~myopn~n dea~occ~ m ~a~ dee pa~a~du~ o~s) andmanner assail.. , , 23.~E, ~DRESS A~ ZfP COo~ ~SON ~g.~ml re{ED mE CAUSE OF O~m ~em 24 ~t) ~ 23b DA~ DEC~ED WAS ~ST 7"=,: .... ' ...: ':,"'~,;.::~~~: 6c~u~ L~ ~ ~ ~r ,. u~ ~., ,.m.~d ....~ ': ;', :.~ '~ ',~ ~'~;~ ~:' 7 ': :'; '-:;"'",77''~" ~'" ' . PART I. ~her ' j.T ~ ~ ':' ~ ~ 3 b~ ~ m~flq In ~e u~q ~use given in Pa~ I I I PERFORMED?i. Yea ~2. ~ I PRIOR TO COMPL~ON OF CAUSE OF o~m? ~.yes ~ 2. No ~ 1. Pm~bly ~nldb~ ~o ~ ~ ~f ~a~ ~S,'? ~T :; ~~at~l ~ 2. A~lde~ ~ 1. ~t p~nanl ~ln past ~ar , ~ 4. I, unkn~n in rela,on ~ the ~b~'d;~?~?i::?;" ,, T : ~ 5. ~uld fiD, be ~ e. P~'~ ~ 3. Not p~nam, b~ p~am ~hln 42 days o~ dealh zga. DAm OF ~NJURY (Mo., Day,. Yr.;~ ~ 29b. ~/~RY~ ~ ~' Zgc. ~HJURY AT WORK? 2~. P~CE OF ~NJURY-. ~ h~, ~ ,~, 2h f ~tor ~ ~0 acade~ ........ :: ::. ,..,.... ....... ..- . ._ , ,,.,. This is to certify that this is a This certified copy is issued · ~. under authority of section 2, ~ Datelssued: March 17 ~ County Sell ,0-Z517868 953 As Amended. ~E: Nangle DIREOTOR'OF VITAL RECORDS