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COOOOl
STATE OF WYOMING )
) ss:
COUNTY OF LINCOLN· )
RECEIVED 9/23/2005 at 2:43 PM
RECEIVING # 912165
BOOK: 599 PAGE: 1
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
-------.-, ___u__
ROLF A. FUNK being first duly sworn upon his oath, deposes and states as
follows:
1. On or about the 26th day of April, 2004, my wife, NORA M. FUNK, died,
as is evidenced by the official certificate of death attached hereto and incorporated herein
by this reference.
2. At the time of her death my wife jointly owned certain real property with
me, said real property being located in the County of Lincoln, State of Wyoming, and
more particularly described as follows:
A tract of land lying in an being a portion of the S 1I2SE1I4 of Section 4, T36N, R119W
of the 6th P.M., Lincoln County, Wyoming, and more particularly described as follows:
Beginning at a point in the South boundary of said Section 4, said point being 1286.70
feet N 89°42' 16" W, from the Southeast corner of said Section 4;
Thence continuing N89°42' 16"W, 658.40 feet;
Thence North 664.07 feet to a point 660 feet South from the North line of first said
S 1I2SE1I4;
Thence S 89°54'07" E, 330.00 feet;
Thence North 660.00 feet to said North line of said S1I2SE1I4;
Thence running S 89° 54'07"E, along last said North line 328.39 feet;
Thence South 1326.34 feet to the point of beginning.
TOGETHER WITH a non-exclusive 60.00 foot wide Easement for ingress and egress
and utilities over, under and through portions of the SE1I4 of Section 4, T36N, R119W of
the 6th P.M. Lincoln County, Wyoming, the center line of said Easement being described
as follows:
Beginning at a point on the center line of the existing McCoy Creek Road said point
being 150.82 feet N 74°01' 18"E, from a BLM type monument for the Southeast
Sixteenth Corner of said Section 4;
Thence S 34°02'40" W, 230.45 feet to a point on the east line of the land described
herein.
Rolf Funk Affidavit of Survivorship
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TOGETHER with any Interest Grantors may have in that certain Private Road Easement
Deed dated January 20, 1987, recorded March 5, 1987, in Book 248P.R. on page 667 of
records of Lincoln County Clerk.
SUBJECT TO all covenants, conditions, easements, exception, restrictions, reservations
and rights of way of sight or record.
Said real property was originally conveyed to ROLF A. FUNK and NORA M. FUNK,
husband and wife, as tenants by the entireties, by Warranty Deed dated October 18, 1996,
and recorded in the Office of the Lincoln County Clerk and Ex-Officio Register of Deeds
on November 12, 1996 in Book 390P.R. Page 387 and Page 388.
3. By reason of my wife's death, I am entitled to sole ownership of the
above-mentioned real property.
DATED this3-/- day of August, 2005
. R~~~
, SUBSCRIBED AND SWORN to and acknowledged before me thiæ- day of
August 2005, by ROLF FUNK.
WITNESS my hand and official seal. . ~
JiQ¡ J. . ,,)Lvk
Notary Public
My Commission Expires:
75 - S-(ii
HEIDf IW)WN -NOTARY Pt8JC '
~ 01 . State 01
Uncaln WyomJng
My CommIssIon expires August 5, 2009
Rolf Funk Affidavit of Survivorship
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LOCAL FILE NUMBER
DECEASE[).....NAME First
STATE OF NEVADA - DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH - SECTION OF VITAL STATISTICS.
I CERTIFICATE OF DEATH I
~' 0 0 :) n 3
I
Q, Il,' 'Ç¡ ";. "f~, /J...' 5
r~LU
Middle
last
DATE OF DEATH (Month, Day. Vear)
1. Nora Harie FUNK
CITY. TOWN OR LOCATION OF DEATH HOSPITAl OR OTHER INSTITUTION-Name (If not either. give stre~t and number)
3b.
Las Vegas
Was Decedent of Hispanic Origin? Specify 0 yes G no If yes.
specify Mexican, Cuban, Puerto Rican, etc. ^
6.
3c.
3017 Childress Drive
FDEATH
OCCURRED W
HSTIIUJlOI
SEE IWœX) (
REGARDING
COIIPl£JlOO OF
RESIOENCE lIDtS
RACE'l~J.;"n~~~~' m~~erican
5. White
STATE OF BIRTH
(If not LJ,SA, name COtJntry)
9a. Monta a
SOCIAL SECURITY NUMBER
CITIZEN OF WHAT COUN- Decedent's Education.
TRY grade completed.
9b. U.S A 10. 12
USUAL OCCUPATION (Give Kind 01 Work Done During Mosl 01
Working Ute, Even If Aelired)
14..
~
(Street ci RF.G. No., City or Town, State, Zip)
City or Town Slate
DDRESS OF FACILITY
Pall øortuary - Cheyenne
PRONOUNCED DEAD (Hour)
22e. AT
8:20 A.M.
PART
I
(6
(a) Arteriosclerc::>tic cardiovascul
DUE TO, OR AS A CONSEQUENCE OF:
, MPH, Medical Exam., 1704 Pinto Lane, Las Vegas, NY 23b. 880
DATE RECEIVED BV REGISTRAR (Mo. Day, Yr.) DEATH DUE TO COMMUNICABLE DISEASE
4b. [APR 3 0 2004
UCENSE NUMBER
CONDITIONS
IF ANY
WHICH GAVE
RISE TO
IMMEDIATE
CAUSE
STATING THE
UNDERL VING
CAUSE LAST
24c.
VESD
Noð
).)
disease
Interval between onset and death
4
Interval between onsel and death
(b)
DUE TO, OR AS A CONSEQUENCE OF:
Interval between onsel and death
PART
g
(c)
OTHER SIGNIFICANT CONDITION5--Conditions contributJng to death but not resulting in the underlying cause given in Parl1. AUTOPSV (Specify WAS CASE REFERRED TO
Yes or No) CORONERffecify Yes or No)
26. No 27., es
DATE OF INJURY (Mo., Day, Yr.) HOUR OF INJURV
DESCRIBE HOW INJURY OCCURRED
ACC., SUICIDE, HOM., UNDET.,
OR PENDING INVEST.
(Specify)
28a.
INJURV AT WORK
~Spedfy Ves or No)
2Be.
281>.
2Bc.
M 28d.
LOCATION.
STREET OR R.F.D. No.
CITY OR TOWN
STATE
PLACE OF INJURV-At home, lann, street, factory. offICe
building. ete. (Specify)
2Bf.
28g.
STATE REGISTRAR
No.
265567
"CERTIFIED TO BE A TRUE AND CORRECT COPY OF THE DOCUMENT ON FILE WITH THE REGISTRAR OF
VITAL STATISTICS, STATE OF NEVADA." This copy was issued by the Clark County Health District from State
certified documents as authorized by the State Board of Health pursuant to NRS 440.175.
NOT VALID
RAISED SEAL
COUNTY '~^LTH
.\. . ~ )-
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j ~ARK COUNTY HEALTH DISTRICT
'>/625 Shadow Lane P.O. Box 3902
Las Vegas, Nevada 89127
702-383-1223
Tax ID# 88-0151573
WITHOUT THE
OF THE CLARK
DISTRICT
DONALD S. KWALICK, MD, M.P.H.
RegIstrar of Vita.l Statistics
BY~
Date Issued:
MAY 0 3 2004
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