HomeMy WebLinkAbout913036
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AFFIDA VIT
STATE OF WYOMING
COUNTY OF LINCOLN
I, Linda Thompson,
being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America over the age of21 years, and a
resident of ß \ ~\¿ .ç.,ó\ , Idaho
That I was well and personally acquainted with Ronald Thompson in that
certain Warranty Deed recorded 12-5-90 , Book 292 P.R., at Page 395
in the office of the Recorder of Lincoln County, Wyoming.
That I know of my own knowledge that Ronald Thompson in the said deed
and ~ono1à.. la.\)-e..'rl'\.. -\-~\TTf\~ mentioned in the attached Certified Copy of
Certificate of Death was one and the same person.
This Affidavit is intended to terminate the joint tenancy (the life estate) of
Ronald Thompson in the following described property:
Beginning at a point which is 17 rods North of the Southwest comer of the SE1/4SE1/4 of
Section 31, T31N, R118W, 6th P.M., Wyoming and running thence South 112 feet; thence West
125 feet; thence North 112 feet; thence East 125 feet, more or less to the point of beginning.
~~1"~~
Li da Thompson
RECEIVED 10/21/2005 at 10:47 AM
RECEIVING # 913036
BOOK: 602 PAGE: 141
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERE~. WY
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1;' 17. Usual Occ~pation (Indicate type or work done during most of working l~e,
"U Mechan1c·. :
Q)
]í 19. Father's Name (Rrst, Middle, Las~ Suffix)
~ Vern Thorn son
8 1. Informant's Name
Linda M. Thomp$o~
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13b. City or Town
Blackfoot
13e. State or Foreign Country
" Idaho
1.6. Surviving Spouse's Name (Give name prior to first marriage)
Linda Goold
13g. Inside City Limits?
o Ves 0 No ro Unk
2. Relationship toDecedenl
Wife.
(DO NOT USERETIREO . 18. Kind of Businessllndust¡y (00 not use Company Name)
. Heavy Equipment .
O. Mother's Name Before First Marriage (First, Middle. Last)
Electa Longhurst
3. MailinÖ· Address~ Number and Strut or RFD No. CR) or Town
1?2E A1rport Rd Blacktoot
51.le
ID
8~P22l
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4. Place of Death, ~ Death Occurred in a Hospital:
Inpatient
5. Facility Name (II not a facility, give number & street or locàUpn)
St John Medical Center . .
: Place of Death, if Dealh Occurred Somewhere Olher lhan a Hospital:
,
,
8. Method of Disposition
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. _ Cause of [)eat.~ (~~. Instructions and examples)
Enter the chain of events": piseases, injuries, or complications - thai directly cau~ed the death. DO NÒT enter terminal events such as cardiac arresl. respiratory arrest, or
entricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Add additional lines If necessary.
C.U (' k
oQ:
r ctì q'v\.
a.
~nrerval between Onset & Death
nterval between Onset & Death
equentially list conditions, if any, leading b.
o the cause listed on line a. Enter the
NOERL YING CAUSE (disease ôr injury
hat initiated the events resulting If!
ealh)LAST
c.
"'þ ; A 1> ~ ..{1i'J'
'nterval between Onset & Dealh
,oterval between Onset & Death
d.
5. Other siQnificant conditions contributinQ to death but not resulting in the underlying cause given above
o Not pregnant, but pregnant within 4.2 days before death
o Not piegnan~ but pregnant 43 days to 1 year before death
o Unknown if re nanl within the ast ear
3. Place of Injury (Ift.g., Decedent's home, conslruciion site, restaurant, wooded area)
7. Were autopsy findings available to
mplete the Cause of Death?
o Ye~ 0 No
8. Manner of Death
[]{Natural 0 Homicide
o Accident 0 Undetermined
o Pendln
1. Date of Injury (MMIODIYYVV)
9. If female'
o Not pregnánt within past year
o Pregnant at lime of death
O. Did tobacco use contribute
to death?
o Yes 0 Probably
ø No 0 Unknown
4. Injury at Work?
DYes 0 No 0 Unk
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Apt No,
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Zi Code+ 4:
7. If trans porta lion Injury, specify:
o Driver/Operator 0 Pedestrian
o Passenger 0 Other (Specify)
8b. Medical Examiner/Coroner· On n:~ b~!:'·'¡s o;.,f f,xa:T1in;:H,on. ~':ì,1'1-'¡ !Í",·'.;!;";ug,,,:j·j!". ¡;~ trl}-"
opif'!it1(j, coal!- t\Çcurren 31 the H~11~1. fJaft"!. ::.s'1d pIa.::". -a"Hl d~!·: !!) tfj~ r;3:i::"f.i·;~';"';i~ :-:';;';!'~~( i;lt...:¡~E\rJ.
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WA 98632
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