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AFFIDAVIT OF SURVIVORSHIP
STATE OF WYOMING
COUNTY OF 1 "vt/L o/)(/
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BERDENA JACOBSEN, of said County and State, being first duly sworn on her
oath, deposes and says:
That BERDENA JACOBSEN is the surviving spouse of DONALD W. JACOBSEN
a/k/a DONALD WILLIAM JACOBSEN, who died 4/20/06, in Salt Lake County, State of
Utah.
That at the time of the death of DONALD W. JACOBSEN a/kla DONALD
WILLIAM JACOBSEN, he owned certain real property by virtue of a certain Warranty
Deed; said lands being more particularly described as follows:
Part of the NEl/4SWl/4 of Section 6, Township 26 North, Range 112 West of
the 6th Principal Meridian, Lincoln County, Wyoming, and more particularly
described as follows, to wit:
Beginning at a point in the East-West mid-section line of said Section 6,
N.89°53 'W., 839.5 feet from the center of said Section 6 where is found a red
quartzite stone 6"x 8"x 8" marked CENT S 6 on the N, on top, and Ss on S;
Thence S.89°53 'E., 339.4 feet to a point which is the NW comer of the
McGinnis Sub-Division;
Thence N.00021 'W., 127.7 feet along the W line of Lot 55 of said Subdivision
to a point,
Thence S.89°51 'W., 339.4 feet to a point;
Thence N.00021 'E., 129.0 feet to the point of beginning; each point being
marked by a steel T-shaped stake 24" long with a brass cap inscribed
"SURVEY POINT DO NOT DISTURB, RLS 164" containing an area of
1.000 acres, more or less; and all in accordance with the map prepared and
filed for record in the office of the County Clerk and Ex-Officio Register of
Deeds in and for said County of Lincoln.
Lot numbered fifty-five (55) of the McGinnis Subdivision, said subdivision
being part of the NEl/4SWl/4 of Section 6, Township 26 North, Range 112
West of the 6th P.M., as surveyed, platted and recorded.
TOGETHER WITH all improvements and appurtenances thereunto
appertaining;
SUBJECT TO reservations and restrictions contained in the United States
patents, to easements and rights-of-way of record or in use, to prior mineral
reservations of record and to all other matters of public record.
This Warranty Deed being recorded in the office of the Sublette County Clerk on
2/11/70, in Book 89PR, Page 268.
That the deceased DONALD W. JACOBSEN a/k/a DONALD WILLIAM
JACOBSEN is one of the grantees in the beforementioned Warranty Deed, and that the
RECEIVED 6/14/2006 at 10:27 AM
RECEIVING # 919314
BOOK: 623 PAGE: 217
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDA VIr OF SURVIVORSHIP
Donald W. Jacobsen
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affiant, BERDENA JACOBSEN is one and the same person as the said BERDENA
JACOBSEN, the other grantee in the beforementioned Warranty Deed.
That the beforementioned Warranty Deed created a tenancy of an estate by the
entireties with full rights of survivorship under the laws of the State of Wyoming and, at the
death of DONALD W. JACOBSEN alkla DONALD WILLIAM JACOBSEN, all equity,
right, title and interest of DONALD W. JACOBSEN alkla DONALD WILLIAM
JACOBSEN, in the beforementioned real property passed to and was vested in BERDENA
JACOBSEN.
That attached hereto and by this reference made a part hereof as though herein set out
in full, is a certified copy of the Certificate of Death of said DONALD W. JACOBSEN a/kJa
DONALD WILLIAM JACOBSEN, deceased.
DATED this fi;( day of ~, 20 oJ:, .
~~~~
BERDENAJAC~
Subscribed and sworn to before me by BERDENA JACOBSEN, this g t::A day
of~:f( ~ I') f7 ~ , 20 Ôt:P .
WITNESS my hand and official seal.
My Commission Expires:
BETTY MOCEIKA - NOTARY PUBLIC
COUNTY OF
LINCOLN
STATE OF
, WYOMING
My Commission Expires 05;29/10
AFFIDA VIr OF SURVIVORSHIP
Donald W. Jacobsen
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