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THE STATE OF IDAHO )
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THE COUNTY OF BONNEVillE )
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RECEIVED 11/10/2005 at 4:16 PM
RECEIVING # 913628
BOOK: 604 PAGE: 539
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT TERMINATING ESTATE BY THE ENTIRETIES
I, Ruth Durgin Cannon of lawful age and first duly sworn according to law, upon
my oath, depose and stete:
1. That I ¡¡m o.f adult age, a resident of Idaho Falls, Idaho, and the Affiant
herein,
2. That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 595PR on page 261 is recorded a Warranty Deed. The
Wemmty D!!!!d, dat!!~ t"~ 1Sth d;;y ~f August, 2005 ::;onv9Ys unto H.
Howard Cannon and Ruth Durgin Cannon, Husband and Wifa as Tenants
by the Entireties tha following described property, to-wit:
lot 40 of Rockbridge Meadows First Addition to the Town of Afton,
Uncoln County, Wyoming as described on the official plat No. 360-D
filed July 14, 2005 as Instrument No. 909983 of the records of the
Lincoln County Clerk.
3. That said Henry Howard Cannon, aka H. Howard Cannon died on the
28th day of September, 2005, and a copy of the original certificate of
death, certified to as true an correct by public authority in which the
origInal of said certificate is a matter of record, is attached hereto as
Exhibit' A " .
4. That by reason of death of said Henry Howard Cannon and by reason of
§2-9-102 W.S. 09S0), the decedents interest and title in said
conveyance has terminated and title to the real property conveyed
thereby has vested absolutely in Ruth Durgin Cannon continuously since
the death of the said do cedent.
FURTHEr¡ AFFIANT SAYETH NOT.
Dated: /1-- 7- 0 r
3G
,I
State of Idaho )
Iss
County of Bonneville )
The forewng instrument was subscribed and sworn to me by Ruth Durgin
Cannon this ~ day of November, 2005.
Witness my hand and official seal.
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My Commission Expires: ({ 2-6/7-0 I (
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Notary Public
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STATE OIi' IDAlIO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
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Dale Filed
OCTOBER 13, 2005
CER'rIPIC_A.TE OP DEATH
State File No.
2005-07846
DECEDwr . LEGAL ''''ME
HENRY HOWARD CANNON
MALE
554-01-2327
88 YEARS
1917
SEX
SOCIAL SECURITY NUMAER
AGE
BIRTHPLACE
ARVADA, COLORADO
IDAHO FALLS, IDAHO
IvVl.RJTAL STATUS AT TIME OF DEATH
MARRIED
RUTH MARIE DURGIN
WAS DECEDENT EVER IN
us. ARMED FORCES?
NO
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w..~AE OF SURVIVING SPOVSE (If wfe, rNiden name)
F-A THER - t.J.-'\ME
BIHTHPLACE
OLIVER WRIGHT CANNON
NEW YORK
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BIRTHPLACE
GRACE E. DAY
COLORADO
METHOD OF DISPOSITION
FUNERAL SERVICE LICENSEE
CREMATION
RYAN REEVES
NAt.\E AND ADDRESS OF FUNEPAL FACILITY
DATE OF I'.[JURY
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WOOD FUNERAL HOME, IDAHO FALLS, IDAHO
DATE OF DEATH
SEPT. 28, 2005
TIME OF DEATH
CITY,TOWn OR LOCATION OF DEATH
COUNTY OF DEATH
2:30 P.M.
IDAHO FALLS, IDAHO
BONNEVIllE
CAUSE OF DEATH (und'''0ng cause ''''1
a,
Approximate Interval Bel'ween
Onset <'Ind Death
ATHEROSCLEROTIC CARDIOVASCULAR DISEASE
YEARS
n'.IE 10 (or as a consequence of):
b
DUE TO (or as 1'1 conSr!quence 01);
c,
DUE TO (or <1.9 ð consequence of)
d.
NATURAL
BRADLEY K. STODDARD, M.D.
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
PHYSICIAN
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not ,"su!!lng In the underlying cau," given above
WAS AN AVfOPSY
PERFORMED?
NONE STATED
MI\NNEn OF DEATH
NAME OF CERTIFIER
TITLE
l.OCATION WHERE INJURY OCCURRED
DESCRIPTION OF HOW INJURY OCCURRED
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This is a true and correct reproduction of the document officially registered and placed
on lile with tile IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS,
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DATE ISSUED: OCTOBER 20, 2005
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JANE S. S~lITH
STATE REGISTRAR
This copy not va!ìd unless prepared on engraved border
displaying stale seal and signature of the Registrar.