HomeMy WebLinkAbout914713
RECEIVED 12/27/2005 at 1029 AM
RECEIVING # 914713
BOOK: 608 PAGE: 221
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
<', (1 r'. ,"''''. r"'~ 1.-11
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AFFIDA vrr OF SURVIVORSHIP
FRANCES A. BROWNING, being oflegal age and being tìrstduly sworn upon oath
according to law, does hereby depose and say that:
]. Ed Browning died on December 24, 2002, in Lincoln County, \-Vyoming, and a
certi tied copy of the official death certificate is attached hereto and made a part hereof.
Î Ed Browning and Frances A. Browning \vere the owners of certain real property
in Teton County, State of Wyoming, vested in them with right of survivorship,
L/lJcüuJ .
3. ~rhe folIo\VÜlg is a descri]Jtion or said real property:
Lot 45 ofTZiver View I\Jeadows First Addition to the Town of Alpine
within the SE/4 of Section 30, T37N, 1<..118W, according to that plat
nled July 2, 1993 as Instrument No. 767416
4. Such property \vas conveyed to such persons as grantees by instrument recorded
February 13,2001 in Book 459 page 456 in the Office of the Clerk of Lincoln County, Wyoming.
5. I do further certify under oath that the deceased, Ed Browning, was the same party
named in and whose death terminated his estate in the real property described herein under the vesting
instrument.
6. The undersigned is the surviving spouse of Ed Browning.
7. This Af1idavit is made for the purpose ofcompJying with applicable Wyoming statutes
providing for the termination ofajoint tenancy in the appropriate statutory manner. The undersigned
sL1rvivCJr continues as the so]e remaining joint tenant with right of slIrvivorsl1ip as to this rea] estate.
Subscribed and sworn to by the undersigned effective f!S9f t1)e I st day of December, 2005.
, --//Í~: //~~.~;¿;'/
.-,- ~, ---", / / /¿~~ - ----------,
.>'l( . c>).í~' ,//~~---____c_~.-:--/ - -- - -.
FRANCES A. B}Ü\\tNING "Co/
(/
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.----..-"
STATE OF WYOMING
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)ss.
)
COUnfY OF TETON
The foregoiLlg instrument was ackl1O\vleclged before me by FRANCES A. BRO\VNING this
'" ;~E!l) clay of, L 2('(:1')/;/) e f'-- , 2005.
[" .
MARY DIVAN - NOTARY PUBLIC
County of ;", State of
leton . , , Wyoming
My Comm;ss;on Exp;,., 'é1-170 f,
~)'------ . '.
My commission expires:
'-2 /)' )
I /. . / ....
Y-,~j(~LHI" I. ¿()(A/l\..)
Notmy Publit
UIU\\ IIIII~ .-\ li"ld<l\"11 I ¡ "\\'lld))
~¡ARRIED FRANKl NAHCON
- . - =---r:-----------
11 ~~C~Df~T:::ER IN US AflMED FORCES? 12a. USUAL OCCUPATION _~-~. 11:::: ~e.~ ~::::/,mosI12b. KIND OF BUSINESS OR INDUSTRY
NO RANCHEH ,. AGIUCULTUHE
;:;~:o;.~c~ "~'"-';oc:~:~'OLN CACI:;~::OC"'~"''0".~~--- C¡:~~"';~::;:':{IVEH DRIVE
13e, INSIDE CITY L.IMITS? 1.. WAS DECEDENT OF lilSPIV-4IC ORl~~-- 15. RACE -Nroi!ric.an Inj¡¡¡r¡
(5p<tcify ye.s rx no) (SçeçUy rQ 00" '(ill it )'ea, 3()ecJly Black., Whita, Etc .
Cuban, Mel(~. Þve<1o RÍçM], Etc.) {Specify}
¡'-"'---:_~; ~-,
,/ .J ~ .
.~" ("\ n ,:'~, ,~"'.
Sl~A TE OF v\rVOIVUNG)u'4:~
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DEPARTI\i1ENT OF HEALTH
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
STATE Fll£ NUMBER
3. DATE OF DEATH (Mo., o.y, it.)
;/ !J D ':'
TYPE
OAPI....H
N
PE RMANE: NT
BUCK
'<K
FDA
INSTRuenoNS
SEE
HAN DBOOK
LC:X:Al FilE NU'-A8ER
1.0ECEDENT-NAJJE FIRST
2. SEX
'-4IDtXE LAST
JONATHAN
NALE
DECENBER 24, 2002
.. SOCIAl SECURITY NUMBER
6 DATE OF BIRTH (Mo-, o.y. Vr)
519-36-5919
APRIL 23, 1937
7A- PLACE Of' DEATH (C~ only ~
~ ~~-~
Olr'lpa11ð111 OER/~~Nursu'Ql~ tJResdef1ce Oou....r(Spðdfy
7b FACIUTY w.J.4E fff no( ,rntJrutico1 gJ.. ttrfHJII It"Jd rA.ITIÒfJI) -~TOWJ{ OR LOCATION OF DEAfH
409 SNAKE RIVER DRIVE __~~~ ALPINE
8 STATE OF BIfHH (It no( r. u.s.A.., I'I4me cc:xxvyJ 9 MARRED, NEVER WRRIED. 10. SURVMNG-SPOUSE (If """fu, Q';"v rT1ooI,i,)"n ~)
W1{)ONfO, DIVORCED (Specify)
7d. C(XJNTY OF DEATH
LINCOLN
IDAHO
YES
, 6 DECEDENT'S ECX,.IC.ATìOH
(SpecHy crly NQhest ¡)"IoUe ~ðd)
No 00
HlIITE
ElemenW-Y/$eçCW"'od.ry (0-12 CoIlegoe (1-~ Of 5+1
12 2
YUO(Spttclfy}
Middle
17, FATHER'S NAME
19b, RELATIONSHIP TO DECEDENT
Fin!
Lut
16 MOTHEA'S NAME
Firs!
J.4idd~
CHARLES
DELIA
MAE
lib.. INFOAt-.4ANT-NAME (T)pe or Pt~J
FRANKl BROIVNING
SPOUSE
,.
1\k, M.J,IUNG ADDRESS
ZIP CODE
STREET OR RFD. NU"-4ßER
CITY OA TOWN
STATE
BOX 3443
ALPINE
HYOt-JING
83128
2()ç. C(:METERY OR CREMATORY-HAME
2Dd. l.OCATlON
CITY OR TOVm
IDAHO FALLS, IDAHO
STATE
BUCK-NILLER-HANN FUNERAL
Num1:>er 2 1c. ADDRESS OF FACILITY
SCHHAB MORTUARY
45
-~ l [)
MaUe-11 Surnaf'Oð
smTll
22c, HOUR OF DEATH
2k. HOUR OF DEATH
M
238. PRONOUNC..ED DEAD (/--Iou)
M
1,4 EASr',FOURTII AVE., AFrON
2Ja. 0" !h"J w,.,ie 0( eumir.elún «"d/or ifNutiQatio<1, in rr'rf opinion de.at't1 occurrlKl
.t the 11.,->11, dt!e v.d p!a.c.e arid due to'the caUS&\1) IIUlIeCl.
(SJQn.4rn,"-,arx:JT7tJ4), .....
230. DATE SIGNED (1.40., D-r, Yr.)
H
8~
E:'5
,20
i ~ I..:) û / µ Q 7 . 00 P M
22d. NAME OF "'Tt~tYSICIAN n:OTHER THAN CEHnflER (Type OT Print)
23<.1. PRONOlHKED DEAD (Mo, 0,,1', Yr.)
2~; NAME AND AOORESS OF CERTIFIER (f't1YSlOAN 00 COAONER)(TtpIII ex Prir()
K. PAUL HEAD
AFT ON, HYONING 83110
25b. DATE RECEIVED BY AEGISTRAR (Uo., o.y, Yr.)
l}ü HOSPITAL LANE
25.. REGISTRAR
~
/ L ' :!-C ·-v 2-
Enlef lha diSð&Su. ¡~un...a, bliooa thaI cauaed de.th, Do ~ enler the rTJ:Xie 01 dylr'Q, --..:;h u cardlac
or ~apir.tor}' lUTul, v.oçk, 0( hN.rl failure. U.t 1=.-11y oroe C*UMI on e..:h ~ne
~..im.l.lot
IIn!ervalB&l_1
IO\&frlarldo...lh
1
1
,
1
1
1
1
1
1
1
I
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1
1
1
IMWE[)lATE CAUSE (final
?LC/rÎ J !2,-V7.;t
DUE TO lOA AS A CONSEOUENCE OF '
-~wt~
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'7 tkt ,~\ ~
dlrse'"'~ Of cr~.,.j.:·Ü:;;'f1
~1IIJt1ng il1 doath¡'"
C--('~ U-r-
Sequent;.)!')' liaI condlliona,
W VI'(,ludirlQ' to Immo6í.a..,
C8146. Ent.... UHDERLYLUoQ
CAUSE (Oi$.ð/l.u Of injury
thatl"'tiated~
ruulting in duth) LAST
DUE TO (OR AS ^ CONSEOUENCE OF)
DUE TO (OR AS A CONSEQUENCE OF)'
d
~RT II. OTHER SJGNIFlCANT CON0400NS-Condiliooa t.on!ributng b death but r\Qt retated 10 ca<..øð gr..en in F¥<.RT I
29 MANNER OF DEATH
30..-; I1UUAY AT WORK?
(Sµ&dfy ,.,S Of no)
NO
30a. D.ATE OF INJ~Y
(Mo::rJ(h. o.y,~)
JOb, TIUE Of
><JURY
NallXaJ D PendinQ
In-atig4/ioo
JO'- UX:,Anoo (51'"1 and NlJmbM or Rurlll Rouk ~ber, Crty or Town, Stahll
><cIdon1
M
VR 2'89
11199 15M
Suiddo
DCQuId ~ be
""'-"""
30e. Pl.&Ce OF f-UJRYcAt homoII, 'arm. atrtIet,/aclory,
oI'ficA buiaJiOoJ..lc.. (SpiK;Jf'/J
llomicide
i 0'1 () -j '1
J j '. _._
fhIS IS a true and ex;:¡ct repruduclion of the document on file in the office of \/ital
F~ecorcls Sel'vlces, Clleyerlne, Wyoming
DATE ISSUED
This copy is not valid unless prepared on paper with
the dale s¡:¡-I! alld signi1tlllc of tho.: Dt:)JUIV S¡~lle Ro.:Qistrar