HomeMy WebLinkAbout912198
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STATE OF WYOMING
-- -- ---RECEIVED 9/26/2005 at 11 :06 AM
RECEIVING # 912198
) BOOK: 599 PAGE: 119
) ss: JEANNE WAGNER
) LINCOLN COUNTY CLERK, KEMMERER. WY
COUNTY OF LINCOLN
KAREN MARIE WILKES being first duly sworn upon her oath, deposes and
states as follows:
1. On or about the 7th day of June, 1992, my father, REX G. WELTY JR.,
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 my father jointly owned certain real property with
my mother, Gwen BjorkmanWelty, said real property being located in the County of
Lincoln, State of Wyoming, and more particularly described as follows:
BEGINNING at the Northwest Corner of Lot 1 in Block 7 of the Afton Townsite,
Lincoln County, Wyoming and running thence South 10 Rods; thence East 5 Rods;
thence North 10 Rods; thence West 5 Rods to the point of beginning, together with water
rights and improvements.
Said real property was originally conveyed to REX G. WELTY JR. and GWEN
BJORKMAN WELTY, husband and wife, as tenants by the entireties, by Warranty Deed
dated November 18, 1989, and recorded in the Office of the Lincoln County Clerk and
~
Ex-Officio Register of Deeds on November 21, 1989 in Book 280P.R. Page 397.
3. By reason of my father's death, my mother was entitled to sole ownership
of the above-mentioned real property.
DATED this :J. 3 day of September, 2005
~-1A- YJ¡z~ u) 4
KAREN MARIE WILKES
PERSONAL REPRESENTATIVE
Wel:y Probate
Affidavit of Survivorship
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SUBSCRIBED AND SWORN to and acknowledged before me thiséB5..- day of
September 2005, by KAREN MARIE W1LKES.
WITNESS my hand and official seal. . ~
~cL W-
Notary Public
My Commission Expires:
o-5-Dr
HEIDI BROWN· NOTARY PUSlJO
COlJn~ of . State d
Unc.:oln WyomIng
My CommIssion ExpIreI August 6, 2009
Welty Probate
Affidavit of Survivorship
2 of 2,
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-00121
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TYPE
OR PRINT
IN
PERMANENT
BUCK
INK
FOR
INSTRUCTIONS
SEE
HANDBOOK
LOCAL FilE NUMBER
1. DECEDENT ·NAME FIRST
Rex
STATE OF WYOMING
DEPARTMENT OF HEALT;~
CERTIFICATE OF DEATH
'-.~'
MIDDLE
STATE FILE NUMBER
3. DATE OF DEATH I Mo., D_r. y"J
June 7, 1992
... SOCIAL SECURITY NUMBER
514-05-2688
Ð_ DATE OF BIRTH (Mo.., Dily. Yr.)
January 10, 1921
1.. PLACE OF DEATH (Check 0II1y OIIe)
~: Olnpali8f\1 OER/Oulpallonl DDOA QJ1::!.£B:
1b. fACIUTV NAME (II r.ot fnslí/ulion, gJvt strest WId numbtJI J
, -..~..~.~,!~:::.,.
o NursIng Hame XJ ResiUence OOlher íSpecifyJ
7c. CITY, TOWN, OR LOCATION Of DEATJII u:'
7d. COUNTY OF DEATH
40 West
2nd Ave.
Lincoln
8. STATE OF BIRTH 01 not k1 U.S.A., name cauntrr)
Kansas
11. WAS DECEDENT EVER IN U.S. ARMED FOACES?
(Specify yes 01 no)
12b. KIND OF BUSINESS OR INDUSTRY
Yes
13a. RESIDENCE· STATE
Wyoming
13b, COUNTY
Lincoln
Mil i tar
13c. CITY, TOWN OR lOCATK>N
Afton
Gover
n
2nd
Ave.
13e. INSIDE CITY lIMITS?
(Spscifr yes Of no)
14. WAS DECEDENT OF HISPANIC ORIGIN?
ISpecily no 0( yes - iI yes, speclly
Cuban, Mexican, Puerlo Rican, Etc.)
Yes
11. fATHER'S NAME
,..,
No J{J Yel 0 (Specify)
Middle Lut
Rex
G.
Welty Sr.
First
B.
Montgomery
19... INFORMANT -NAME 'Type Of Print)
Gwen Welty
19b. RELATIONSHIP TO DECEDENT
Spouse
'0 ,
19C. MAILING ADDRESS
STREET OR R.F.D. NUMBER
CITY OR TOWN
Afton
STATE
ZiP CODE
Box 41
WY
83110
.,
.,>","
20.. Bt.orial, Cremation. Removal
.rom SI.,., Other l$pecUyl
20b. DATE (Mo.. o.y, Yr,)
CITY OR TOWN
STATE
23c. HOUR Of DEATH
23d. PRONOUNCED D~ (~o;, D~y, YrJ
M
23., PRONOUNCED DEAD (Hcxr)
M
25.. REGISTRAR
25b. DATE AI;CEIVED BY REGISTRAR 11.40., D.y. Yr.)
(Si .'I¥.J ....
PART I. Enter lhe dis.ase',lnluri ,or complicalionl thai caused death. 00 riol enter the mode 01 dying, such .s cardiac
26. or resplralory arrell, shock, Ol hurl failtJr.. UsI only one (;I:OS. on each line,
IMMEDIATE CAUSE (Anal
disease or condition
res\JIlng In death) ..
6-/$"-92..
)
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DUE TO (OR AS A CONSEQUENCE OF):
DUE TO (OR AS A CONSEQUENCE OF):
, In PART I.
No
30b. TIME m' 30e. INJURV AT WORK?
INJlI~Y ($padfy ye.s 01 no)
SuIcide
o Could not be
Determined
M
30e. PLACE OF INJURY-AI home. farm. alrut, !aclory. 301. LOCATION ISlreel end Number 01' Aural Raul. Number, City or Town. S'.le)
office buik:llng, ale, (SpecJty)
Homlclda
THIS IS TO CERTIFY that this reproduction is~a true
copy of a record on fi 1 e in Wyomi ng Vi ta 1 Records
Services, Cheyenne, Wyoming.
This copy is not valid
seal and the signature
Registrar is in red.
unless
of
it
the
bears a
Deputy
raised
State
Date Issued
June 18, 1992