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RECEIVED 9/22/2005 at 11 :07 AM
RECEIVING # 912102
BOOK: 598 PAGE: 704
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
\_, 00704
AFFIDAVIT REGARDING DEATH OF TED L. ROBERTS
THE STATE OF WYOMING
ss.
COUNTY OF LINCOLN
Bonnie M. Weston,
I
being first duly sworn upon her oath,
deposes and states as follows:
1. On or about the 17th day of February,
1999, Theodore
/
/
/
Llewellyn Roberts, a/k/a Ted L. Roberts, died, as is evidenced by
the official certificate of death attached hereto and incorporated
herein by this reference.
2. At the time of his death, Ted L. Roberts owned with his
wife, as joint tenants with full rights of survivorship and not as
tenants in common, certain real property located in the County of
Lincoln, State of Wyoming, and which is more particularly described
as follows:
Parcel 53 of the Town of Diamondville, Wyoming, as shown
upon the plat thereof dated August 31, 1942, containing
5000 square feet, more or less.
3. This Affidavit is filed for the purpose of establishing
the fact of the death of said Ted L. Roberts and to make an
official record of the termination of interest of said decedent in
and to the above-described real property.
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DATED this JG - day of
, 2005.
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B NNIE M. WESTON
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SUB~;~I~~D f~~h::L; ~ and, a~~~~~l~~g:~nn~:f~~e w:seto~~is
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WITNESS my hand and official S~~i'~~A
My Commission Expires:
.1//9/1
Heidi Beachler· Notary Public
County of' . State of
Lnco!n Wyoming
My Commission Expires !1 J¡9 /7
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