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THE STATE OF WYOMING )
)SS
THE COUNTY OF LINCOLN )
AFFIDA VIT TERMINA TlNC ESTATE BY
JOINT TENANCY
Gaye Lynn Hepworth, being of lawful age and first duly sworn according to law, upon my
oath, depose and state:
1. That Waldo E. Hepworth died on July 4, 2005 in Afton, Wyoming.
2. That on January 10, 1994 for valuable consideration Florize Hepworth by her
Warranty Deed of that date, which deed was duly filed for record in the Office of the Lincoln
Cuunty Clerk on ¡anury 25, 1994 in Book 344PR on page 385, conveyed unto Waldo E. Hepworth
and Gaye Lynn Hepwol1h, as joint tenants with full nghts of survivorship, the following described
real property, to wit:
BEGINNING at a point 55 feet West of the East Quarter Corner of Section 31, T33N R118W
of the 6th P.M., Lincoln County, Wyoming at a survey marker inscribed:
PLS 5368, T.33N., R.118W., S.31
16.7 R.M. 1990
and, running thence West, 198 feet;
thence South, 220 feet;
thence East, 198 feet;
thence North, 220 feet to the POINT OF BEGINNING.
3. That by reason of the said conveyance, Waldo E. Hepworth and Gaye Lynn Hepworth
became the owners of the real property as joint tenants and title thereto vested in them continuously
from said date of conveyance as described in said Warranty Deed, until the date of death of Waldo
E. Hepwol1h on )uly 4, 2005 at which time title to the above described real property vested
absolutely in Gaye Lynn Hepworth in accordance with the provisions of §2-9-102, W.s. (1980).
4. Affiant avers and certifies that deceased is the identical party named with Affiant in
the aforementioned deed whose death terminated his interest, title and estate In the said real
property; and Affiant attaches hereto and makes a part of this Affidavit a copy of the official
certificate of death of decedent, duly certified by the public aothority in which said death certincate
is a matter of record.
Dated this r:10""0of October, 2005.
State of Wyoming
County of Lincoln
7J, The foregoing instrument was subscribed and sworn to me by Gaye Lynn Hepworth this
.;JO.- day of October, 2005.
Witness my hand and official seal.
ߣ~aJN ~
Not ry Public
My Commission Expires:
9-/5-D7
GLORIA K. BYERS - NOTARY PUBLIC
County of State of
Lincoln Wyoming
My CommissIon Expires Sept. 15, 2007
RECEIVED 10/24/2005 at 4:26 PM
RECEIVING # 913101
BOOK: 602 PAGE: 357
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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ST A TE·OFWYOMING
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DEPARTMENT OF HEALTH
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2005-nnlgQ?
STAtE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
STArE FILE NUMBER
LOCAL FILE NUMBER
3. DATE OF OE;ATH (MoIDayNr)· (Spell Montt1
1, OECEOENT'S lEGAL NAME (ír,eludll AKA''!i iI,any) {Firs!, Mldd!e. Laslj
Waldo 1';- HEPWORTH
~
ulÿ 4,2005
·1 SOCIAL SECURITY NUMBER
6. DATE OF BIRTH {MOfIJBYrY.}
520-42-4776
anuary,'23, 1938
: : - _:_ >. 7a_ PLAÇ,E or: DEATH (Cþðck only onel
IF DEATH .oCCURRED 1~ A HOSPITAL. ,-: TT IF OEATH:OCC~~RED 5þMEW~tERE å~:t'tI;:R THAN Aliós~rrAl':::' ,:::' >:: <:
_~~-=-º-~ j O(llll¡¡tlenl~-.-J_O HosplL'1! FacIlity ,,0 Nursing Home ¡long Term Calli Faclllly ':, . . d Dece®nfs liome
7b, fAC!lITY NAME (It OOlloSllluOO". g;...e shuul and nU!I1bllr) 7c. CfTY, TOWN, OR lOCATION OF DEAHl
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Star Valley Medical Center
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9 MARfT.A,l'·STATW~ AT TI~E'oF Oëi'TH
ø M.¡¡~i~.~'., " 0 í.!1I;;Ied. ;~~I 5ep.~¡:.led
:' LJ DIVorced", 0 NII...el M.ilflled
~[, ',',' ,12Þ CO, UN1.Ý ,
-=--', Liocoln
8 BIRTHPlACE ¡èily an~ slale C>i 'or"9n count~1
Grover, Wyoming
,iEvER 'N U S T" RESIDENCE ",STÀT,E
AHMED FORCES'
-º-!~~NO 1iYomiflß ,'."
!;¡'01 S-:-~~!':r:1 /,r:;] t;l; .1~:::P,
7l,3 Grover Narrow's Rd.
I, It 1 :~~::;!<I!:": cr[';"1.~~~IT~7
,{, tJ "';E5 XXI tm
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13 fATHER'S NAME (Fusl, Midól". Lul)
Fay Edmund "epwoFth
1 Sa INFORMANT'S NAME
FlorizeEdwards
15b, REI,ATIONs!·np TO þEC¡;:OSNT
1sÇ, MAilING "O.QRESS·(S"IÚI.I.nó NUn-;be;. è"y. S'løle, Zip Çpde
Gaye Lynn Hèpworth
,- :-:. ,', ",', '; .',..,"
743 Gr¿)ver N~rt'~w§ Rd. ;Grover~rlWy 83122
Spouse
17a. PLACE OF OISPOSlnON ¡Name 01
, cem.tery01 cleffillloryl \
c;roverCeT11etEHY
17u.lOCAT10N - CITY OR TOWN AND STATE
19~::N"ME OF fACILrrV
rover, Wyoming
19b: AOO~,ESS OF FACI~, rv ':
,4. ¡;;,.4th Ave.; ffton, WY
23. W"S CORONER CQtHACTE07
Srihwab Mört uäry'
XO'll~ES DNa
^ppro"maleifllefYjll
OnS8110 ooalh
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years
This is a true and exact reproduction of the document on file 'jn the office of Vilal
Records S~rvices, C ~eyenn~, Wyoming,
,0..,-.",. ú~.,.¿&..-;. ~/... ýi~7.....,
:, Lucinda McCaffrey /:/
Def?uty Slale RegIstrar
DATE ISSUED:
\
JUL 21
2005
This c~py i.~ not vi,ltid unless µrepareJ on paper with an e.ngraved bOTder displaying the: date¡.seal and s;gnatu!e or.lhe Deputy Slate Re.gislrar
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