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HomeMy WebLinkAbout913652 STATE OF WYOMING ) ) ss: ) (' ,.... (, ~~,~ r') 0 ,\ , ' D RECEIVED 11/14/2005 at 10:51 AM RECEIVING # 913652 BOOK: 604 PAGE: 578 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 Th day of June, 1992, my father, REX G. WELTY JR" died, as is evidenced by the official certificate of cleath 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 Bjorkman Welty, said real property being located in the County of Lincoln, State of Wyoming, and more particularly described as fol]ows: BEGINNING at the Northeast Corner of Lot One (1), Block Seventeen (17) in the Town of Afton Townsite survey, Lincoln County, Wyoming, then running West Five (5) rods, thence South Five (5) rods, thence East Five (5) rods, thence North Five (5) rods, to the place of beginning, containing in aJl Twenty-five (25) square rods, together with all improvements thereon and appurtenances thereto. Said real property was originally conveyed to REX G, WELTY JR. and GWEN WELTY, husband and wife, as tenants by the entireties, by Warranty Deed dated October 14, 1981, and recorded in the Office of the Lincoln County Clerk and Ex-Officio Register of Deeds October 15,1981 in Book18JP,R. Page 584. 3. By reason of my father's death, my mother was entitled to sole ownership of the above-mentioned real property. DA TED this _~ day of November, 2005 ;''1) ,'J ", ,'-I()"J i '<dccL~t< J 1a.'l<ê. . '((':.1(J KAREN MARJE WILKES PERSONAL REPRESENTATIVE Wélty Probate Affidavit of Survivorship I of 2 I- G~iZ rnor:~np '., ',,1\,./0 (J \\~ SUBSCRIBED AND SWORN to and acknowledged before me this L day of November 2005, by KAREN MARIE WILKES. WITNESS my hand and official seal. (lléJ~d_ . Notary Public // / ./ ( My Commission Expires: [} - C\ ., . ~> C> -¡ HEIDI BROWN· NOTAHY PUalJO Cöunty of SteM of Uncoln WyölTJna My Comrrdssloo ExpIIti3 Augua!d 5, 2009 , ~, ~. , , Well)' Prohale Affidavit of Survivorship 2 of 2 \ .. :.' "..." ~'~¡ ,(:- /L"'" ;,v-'... ,; (', <~.ç n n r~: (,) U() \.·'\)0'0(.) ',-I n ..f.', .' ,-JüJ¿1 {,*llt<, j,-~Si8 lyrE OHHut..T IN PEfJt.W ENT BLAG ( ".. FOR INSTRUCTIONS SEE HANDBOOK . , . ~ . . . <>.<t't '6 ,\.!r ,\. \,')\"- ') VR 2'8.1). 2/91 ~5M STATE OF WYOMING DEPARTMENT OF HEALTH CERTIFICATE OF DEATH LOCAL fll E tJUr,1BER I DECEDENT-/ M.IE FiRST Rex "1IDDLE 2 SEX STArE FILE /HJI.tUER 3 DATE OF DEATII (Afu, D,,~. Yr.) June 7, 1992 lAST G. ¡·Jel ty ,Jr. Male .¡ SOCIAL SECURITY NUMBER 514-05-2688 J- :;-¡GE'L,~ Bir¡ll(j;¡y rY,~,) 71 ---- "v",;,~:ffi'ªf~;~ÁIJ}~, ''j~~EC=- G~:I~)~~r;~V' ;'t;'~~- - ~._~ ---- (. \,V¡'':-:--:-:- -~~___n 7;). PLACE OF DEATH (C/¡ccl< Dn/, ona) 1i()SPITAl fQuiŒ-- -=---=-~ 0 !"pol.wl 0 tR/~~\~ _º~~~ 0 IJu ~u \J ¡¡"'I(,,,, XJ n~~.k"~,, 7b F,\CIU1Y NAt,lf (II ~ür if1~f¡!uli(,ll. çjyU s/f.:d dJ14 nUlllb,y) ---~-----~- (JOII,'::II$¡Jc:cify ',-CITY1¿;;':¡:JC:Jïtt:ùCATIDtj Of OEArH \', _---.'lQ_..tJe s !.._.-Lf!g_A v e-,-_ ______ _ _A.-ftOD______ '3 !1A.Rr¡¡EO tlEVEti 1\...í.,r~It:O [10 ::,uH,lIlIh3 :::;POllSE (II WII..: !I' " "J,,'('~1 niJl/lt:) WIDO\'.ED OIVl fj, fO ¡t.po;Clly} ~Lé!£fi~-ª- .-___ _,gll,ª-D_ J2iQrJi!naIll--- _____ __ _.____ ___ 12¡¡, U3UAl ()LClJI"I\.T¡O¡ (G ~ ~/I1J vI 1'1.,1; duoo; (JUI,n') I ILJ~I 1.:-t,. ~lra) OF OU~ltH S~ 011 JtlDU::;HIY 1;1 w"j"u1:.ì /¡It: e,,~¡¡ ¡/ ("Iliad} ____Nilil~ª£y ___ J),S,~Qvernm,:Ult '~:jC~~~ln ,"'~I~~O~'~ORlOCAflO" ]"~';m\~'~~U~BEn 2nd Ave. 13; IIISIÕÊ CJTì' llt.ílTš?--- ï:i"v:;,s DECEÔEi7fõf"HisP'''tIIC ORIGIN? ---- 15 ¡i.\C·~-';I¡':~~·¡;;'~--- (S{1<Jcifj' J'tI:i Of no) ¡S¡-.o:cily 0\0 or :':"" . i/ ' <:~, ~p.::~i ,. U!Jcl<. W¡.i¡.:, EIe CLot'II\, M'::¡'':'''I, P"ÜllJ Aiciin, flel (S¡"iJ~i/O --[,J"CóíJtn'( Of DEAlII _ J~irLcOI!l_ f STATE Of BIRTH (If nol Ùl U5k, {¡WII", COUIIII)') Kansas ~'Ê[)"E'EEDEtri-EVER IN US ARLIE() fORCES? (Spé:.cilr ¡CIS CJ1 liD) Yes 1 Ja RE SIOENCE . STATE ¡\lyom i ng Yes Ò OECf[¡[NT'S [Ouc.4nON {5p"äly ú/Jr f¡':ill"'~1 'J'utJ", "....Jli,'u/"u} ¡:¡'''''c'''''í5''~CO'''J' (1-~" "I t.\iud!.: M..icj"n S<J¡n¡¡1'/W NOXJ Ye~ 0 (Spt<cil)' 1,lido!¡¡ 19D. RElATIO¡,¡SHIP TO O£CEOErH 11 FATtiER'S tJAME F¡¡:;I l"~1 Fjl~ Hex G. Welty Sr. B. Montgornery 1% UlfORt.\AfH -NAI.1E (T)'Ii" Of Print) Gwen Welty Spouse 19~, MAILUm ÃODRESS ::iTAEET on RF 0 NÙMBEA en'( on TOWN STATE ZIP COOl:. Box 41 Atton ~'·¡Y 83110 20.. ~~::'s~~::nð:~~~:' f;;J~~~t:1 20<: CEt,IETERY OR CnH.IATOHY-NAME 20d. lOCMION cln OR TOWr~ STATE - ,......A ftQn <---\^lymrring.__ tlumL.;( ::! 1[ AOOI1E:;S cr FACILITY 231..0 O¡ô¡{S'ìGtIED (Atù D,,¡'. '(r) _=I:JC. HOUR OF OEAJli -- --~~---'--- --- -~ -----~- '" eRO""""CED DEW 1M, a" YoJ .Jc pr,O"D'''KED DEAa III:' ---~--~ ------~- 25.. AEGISTRAR :i5t.. DATE RECEIVED BY nEl'iISTnAR {I,lo, 0"1. Yf.} is,,,,,,",,, ~ _ t -/ ~ - 92- PAnT Enlal lilt! di~<:J:i"S, inj¡'fÍ s. ,"r CúoIlµlic¡]li"IlS Ihal c.JIJsi:;d ¡J.,:¡lh 0.:. f\ùl ",nlur In.. IIlcdo: 01 d,ill\ . ~\Jch i.I:> cardi¡¡c A¡,¡;ro~ill¡"ta 2ó 0( 1I;:~pi,;;¡v(J' ( lIù:.t, ~I,od. 01 h.,¡HI bi¡,,,,, lí~1 u¡,I" or,.. çalJ~~ on ..Jel\ lim: 111I1"r'''1 Ð.:I""un :I::'::::~;,E~:::~:~~ ¡FIo,' jdelil ã1;A3t ~=-_~tt{X1L!J_~~l~~_ß~I<):J~, ___1°{; ;:" _ DuE TO (nri AS A L.ONSEOLJEfJCE Of} $,;L Uclllull, lhot CU¡jjlli"H$, f b DII' TO ¡OR AS A COtÙau';;C,o~'-----~------"'- '-¡,~~__ il MI/.I..¡¡JiB!J liJimm"diilt¡: C¡¡LJS., EIII!;( u~JOEm '(ING 1 I CAUSE {UI:>"a:.o: or I~"'( C ----------C;Ue TO (C.R AS A-C')/I~EOÜE,.CE OF) ~-- ~---------__ ~_ ~__~ ~______ !lliil mlliJI"d t!Vi Jl~ I r,,~uU ¡¡ In de..U,¡ lAST t " .L PAAT 1=::¿SN~_C~T¡::Ç::~"t."''''O 'c ",,'" b.., ,,,' ,"","", """ ","" '" PAra 1 _~___ _ L ~J~~~S~;~',~ ~a :¡J;..~;:~~~'~T~cUnOt~'"-_ 2!J t.IÃtJNER OF DEATii JO.. DATE CF ItJJURY 30t; TIMË OF rOc, IIJJURY ,1,,1 WOf'iK7 ¡.iW. [JESCRI8E Hov/lruurw úCClJRI1ED (Mü( lh. Dill, y",,,, J ItUUHY {S(/b.:;dl fd 0' IIOJ Hiltur..1 Df'i.H1JiUíl h¡'>tJ;;li,:¡..tiùll A.:ciJ..nl M [J 30~-PLAcEoF"i ¡jurW-At t;"¿;,~,,,,·-~I~dO,~. ---~- 30TÎ.I::·..c;;:TIO¡::¡(~;:;d~-;;- AUf,,! H()ul~~-:;-;~ê-i¡:¡--;;rû""n, SI¡¡!;¡ ~Ji.:;i( e Coulj nol I:J~ o/fief; Luildi"\J ..I.:; (Spt:.;ily .. DcI"rmÎr\C:(j IIurniclae THIS IS TO CERTIFY that this reproduction is a true copy of a record on fi lei n Wyorni ng Vi ta 1 Records Services, Cheyenne, Wyoming. This copy is not valid unless seal and the signature of Registrar is in red. it the bears a Deputy r'ai sed S ta te Date Issued June 18, ]992 ::;:_ ,.' Ù "---I " ,,) ~ ./¿ ¿/-/-'"..!ÞY./"(~ ./;//',~,/"..;,/?:::~ ?/__ --,-- .- ..-- /;,_;/.Ä¿~~..4.~-'~'~~' ~-l)eputystate RegEft'ðt,/',,;t=7 /P ÍL/