HomeMy WebLinkAbout914292
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RECEIVED 121712005 at 4:02 PM
RECEIVING # 914292
BOOK: 607 PAGE: 125
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
.THE STATE OF WYOMING
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AFFIDA VIT TER4j~::ÄT(NC ESTA TE BY
JOI Nt/tf&ANCY
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Atìdr~wJélYLa~land, being of lawfuI,fM::f:)1d first duly sworn according to law, upon my
oath, deposednd state, .. . :}:::1(:::' .
1: Tlié1t Lee Roy Layland died onp:~:Wmber 1, 1997 in Grover, Wyoming,
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2", . That on November 13, 1996 f()r::y~!Gable consideration Lee Roy Layland and Norma
by their Warranty Deed of that date,Wþj~h deed was duly filed for record in the office of
the Lincoln County Clerk on March 17, 1997¡r):~~qpk 394PR on page 842, conveyed untu Lee Roy
Norma Layland, Andrew Jay Layland \1d~t.èarbara A. Layland as joint tenants witb full rights
survivorship,the following described real P'@JÄrty, to \yit:' .
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COUNTY OF LINCOLN
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BEGINNING at a point which is1ß:~;::\;teet North of the Southeast corner Qf l.ot 2
(NWY4NW!4) of Sectionl, T32N Rl1$w\þf the 6th P.M., Lincoln County, Wyoming;
thene¡: North, 170 feet; . ':;:,:::::: (, .
thenceWest,200 feet; :.,/:}:;":
thence South 1 70 feet· . . i:::;}::
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thence East, 200 feet to the POINT O(:SÊ(¡'INNING.
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3., That by reasonof the said conv~)(ånce, Lee r<oy Layl;:¡nJ, Norma Layland, Andrew
Jðylayiand and Barbara A. Layland becéJrne the:'ÞNhers of the real property as joint tenants and title
,'.thereto Vested in them continuously from sai(rß@~ of conveyancèasdescribed in said Warranty
,':Deed, unti I the date of death of Lee Roy Layla6~(¢n December 1,1997 at which time title ,to the
'¡:¡bove described real property vested absol utel,/Ú'L Norma Layland, Andrew Jay Layland and Barbara
:A. Layland in accordance with the provisions oC§,:~-9-102, W.S. (1980).
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4.. Affiant avers and certifies that diç~a,sed is the identical paltynamed with Affiant in
'....·the aforè[lls:ntioned deedwhòse death termÎrl:~'f~·q his interest, title and estate in the said real
,,' 'pr~perty; and Affiant attaches hereto and maMV:,a part of this Affidavil acopy of the official
certificate ofcjeath ofdecedent,;duly certified by:jh~ public authority in which said death certifi(:ale
.isa matterOfJe.co'rd. ':::::::::;. .
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(9¿ C. .:.::"},:¡~ 2005.
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of Wyoming
of Lincoln
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scribe¥.*Hd sworn to meby Andrew Jay Layland this
2005<::;::::::.::'
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Witness my hand and official seal.
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GLORI;', 1<' [jYEr~s"':',Ic)T;RY 'i)u~-l~C~'-
COLilìtyof };,(¡t\ State of .
L' /. · II'¡" ;~J!~ . .
¡nco 11 (,ifiØ Wyoming'
My Commission Expires Sept. 15, 2007.
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sour Al~E OF WYOMING
DEPARTMENT OF HEALTH
1YÆ
on PRINT
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PERI-.w.¡EN,
Bl.A.CK
fojK
FOR
IN5rnUCTlONS
SEE
HANDBOOK
LOCAL FILE NUMBER
1 DECEDENT· NAME FIRST
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
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MIDDlE
2. SEX
STATE FilE ~ UMBER
3. DATE or nEATH (Mo_., Day" 'r'r,'
LAST
LEE
HALE
DECENJ3ER 1,
1997
.01, SOCIAL SECURITY NUMBER
6. DATE OF nlRTH (Mo.. Day, Yr.
520-36-0009
SEPTEHBER 18,
1921
7 B_ PLACE OF DE,mt (Check _ oo/y ÓflØ)
t\oSPtTAl: ~
OtnpBlieol L!ER/Outpalianl,DoOA '
1b FACILITY NAME Of nof InsUtuCiOfJ, gIve sues' and n!Yßb6f J
1d. COUNTY OF DEATH
51 FIRST STREET
GROVER
LINCOLN
8 STATE OF BIRTH Iff nol Íf1 U_S.A" na<nfJ CouflfryJ
10 SunVIVING SPOUSE (If WI!s, give maiden name)
HYOHING
NORHAGOODRIèK
n. WAS DECEDENT EVER IN U,S ARMEO FCI1CES?
(Specify yes or no)
12a, USUAL OCCUPATlOt~ (Give - ~,ifld of worlc done dlliDg most
01 \MY1o;iI1g li/s, 6\-"en H fe(ired)
RANCH HAND
12b. KIND OF BUSINESS OR [lmUSTRY
NO
AGRICULTURE
13a. RESIDENCE - STATE
1Jb_ COUNT,Y
Dc. CITY, 10....m OR LOCATION
[nd STREET AIm NIJ>.18E~
51 FIRST STREET
HYOHING
LINCOLN
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~Ñ~,IOE CITY uMriS?__ ----"--, j1'~\'.'.^...SDECED. EN..'.'.'.'. ~5P. AN.'.'C.·.0RIGIN?--
(Spec!ly res or no) !~peclfy no or yes - if yas, !lpecily
NO Cuban, Me~lCan, Puerto Rican, EI..:)
tJ~'{X Yes 0 (Spt!-clfy)
Middle
M<li&n SlJH\ßme
CiWVER
15_ RACE-Ame'ìcaolrx:1ian,
Black, While, Etc.
(Spðcify)
'6. CECEDENr's EDUC.JtnCW
(Spec/lronly N¡¡host rJ'liIdfJ compldlttdJ
Elemenl_al"/Secorda'" (0-1:? CoIleg<J (1·4 or S+)
~':.
----)
AVE., AFTON
ImITE
8
JAIRL
last
lB. MOTHER'S NAME
Fi"l
Mkjdle
ROY
LAYLAND
HAZEL
198, INFORMANT-W,ME (T)pe Of Print)
1 9b RELATIONSHIP TO DECEDEtH
NORNA LAYLAND
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11k MAILING ADDRESS
STREET OR Rf.D_ tlUµBEA
CIl Y OR TOWN
STATE
ZIP CODE
C:WVER
83122
CITY OR TOWN
STATE
GROVER
I-lYOmNG
23a On the basis of c~amif\ðllon ð~ / or InveulÏgalion, in my DP. oIon death occurred
at ltoe time, date ;U1<j µlace and due 10 the CIIUSe{S) slated.
(SJrJrJlitlXe 8nd nUe) .....
23b. DAT~ SIGNED {Mo, Day,
AfI.
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~g
I~
uO
El5
",u
23e_ PRONOUNCED DEAD {HrxrJ
23c. HOUR OF DEATH
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23d, PROt~OUNCED DEAD (Mo., Day, y",
24,~AME Arm ADDRESS OF-CERTlFIER,(ÞHYSICIAN OACORONER)(Type r:x- Prill"
O. D, PERKES ND
110 HOSPITAL LANE
AFTON
WYOHING
83110
25a. REGISTRAR
/;J. <1- ?/
25b, O"TE RECEIVED BY REGISTRAR (Ma" Dey, Yr.)
(Si 1due' .... ~
PART I, Ente, Ihe d¡seas~~. ¡~uries, or ccmplicøtlons l11at caused death. Do nol enle' the mode 01 ·d¡'ir.g, such as cardl3C
26 or resp/ralol)' BHost, shock, _or hearl,:lallura U,! onlV: one c.ause ~,ea,ch line
IMMEDIATE CAUSE ¡Final ;(l . trlJ £
disease or cundltion' . ~ ._.... \ : . . ~ ..
Œ<uIJ;',,;od"thJ" ,_~d-'0~ I~Ct4l/2-CI r1 ðy\/lQ..J ~(7.&>!
D~S A CONSEQUENCE OF I:
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SeQuentially Il5t conditions,
H any,lea,jing 10 immedk..:tte
cauu_ EnlOf UNDERLYINQ
CAUSE \Disease or injury
IMI initialed e...-anll
relulting 10 dealhlLAST
DUE TO (OR A$ A CONSEQUEt~CE OF):
DUE TO (OR AS A CONSEQlJEt CE -õFj:-
d
~RT I). OTHER SIGN!F1CANr CONOITIONS.Coodil_iexls ~ontribul;ng () dealh but not related 10 cause given In PART I.
29, MANNER OF DEATH
30b, TIME Of
INJlInY
3Qc, INJURY AT '''"ORK?
{Spedfy res Oi no
NO
30a DATE OF INJURY
(ManU!. Day, Yew
N.11urid
o Pending
_ InwslOgatioo
Acciðe"t
M
30e, PlACE OF ItUUA'{ - AI home, farm, slreel, lactor",
oltice Wlding_ alc, (Sp/JcNy)
301. lOCA110N (Street Ind Numb1J! or Aural Route Number, CIty or 'Town, State'
041C128