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C00238
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RECEIVING # 91 S¡¡;ið:~*:¡i:~
BOOK: 624 PAGE: 238
JEANNE WAGNER
.LINCOLN_C9LJtfJ"Y ClERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
:ilmm;;~I~llim
STATE OF WYOMING )
^ )ss.
COUNTY OF ~-f~¿ )
BERDENA JACOBSEN, of said County and State, be.ing:first duly sworn on her
oath, Deposes and says:
ThatBERDENAJACOBSEN is the surviving spouse of DONALD W. JACOBSEN
~lkhlDONALD WILLIAM JACOBSEN, who died 4120/06, .in SaltLake County, State of
Utah.
That at 1he time of 1he Death of DONALD W. JACOBSEN ß!k/a DONALD
WILLIAM JACOBSEN, he owned certain real property by virtue of a certain Warranty
Deed; said lands be.ing more pID1icularly described as follows:
Part oftheNElJ4SW1/4 of Section 6, Township 26 Nortb,Range 112 West of
1he 6th Principal Meridian, Lincoln County, Wyoming, and more pID1icularly
described as follows, to wit:
Beginnin,e 1:1t a point .in the East-West mid-section line of .said Section t),
N. 89°53 'W., 839.5 feet from the center of .said Section 6 where is found 1:1 red
quartzite 5tone t)~'x 8''x 8" marked CENT S t) 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;
ThenceN.00021 ~W.~ 127.7 feet1ll0ngthe Wline of Lot 55 of said Subdivision
to a point.,
Thence S.89°5rW., 339.4 feet to a point;
Thence N.00021 'E.~ 129.0 feet 10 the point of bei?nning; each point be.ing
marked by a .steel T-shaped stake 24~' long with a brass cap inscribed
""SURVEY POINT DO NOT DISTURB, RLS 164~' containin,e an area of
1.000 llCIes, 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 ~gister of
Deeds .in and for said County of Lincoln.
Lot Dlnnbered.fifty-five (55) of the McGinnis Subdivision,.said .subdivision
be.ingpart oftheNElJ4SWl/4 of Section 6, Township 26 North, Range 112
West of the t)th P.M., as surveyed, platted and recorded.
TOGETIffiR WTIE 1111 improvements :and 1:1ppurtenances, thereunto '
appertaining;
SUBJECT TO reservations and restrictions contained .in the United States
patents, 10 easements and rights-of-way of record or in use, 10 prior miner1ll
reserv.atÏons of record and 10 all other matters of public record.
This Warranty Deed being recorded in the office of the Lincoln County Clerk on
2/11nO, in Book 89PR, Page 268.
That the deceased DONALD W. JACOBSEN ß!k/a DONALD WILLIAM
JACOBSEN is one of the grantees .in the beforementioned Warranty Deed, and 1hat the
AFFIDAVIT OF SURVIVORSHIP
Donald W. Juobsen
P11ge ] of2
j
C00239
09'19598
affiant, BERDENA JACOBSEN ìs one and the same person as the saìd BERDENA
JACOBSEN, the other grantee in the beforementìoned Warranty Deed.
That the beforementìoned Warranty Deed created a tenancy of an estate by the
entiretìes wìth full rìghts of survìvorshìp under the laws ofthe State ofWyomìng and, at the
death of DONALD W. JACOBSEN a/kJa DONALD WILLIAM JACOBSEN, all equìty,
rìght, tìtle and ìnterest of DONALD W. JACOBSEN a/kJa DONALD WILLIAM
JACOBSEN, ìn the beforementìoned real property passed to and was vested ìn BERDENA
JACOBSEN.
That attached hereto and by this reference made a part hereof as though herem set out
in full, is a certified copy of the Certìficate of Death of said DONALD W. JACOBSEN alk/a
DONALD WILLIAM JACOBSEN, deceased.
DATED this 1¡fJ1dayof ~, ,20 at; .
~rV /,
BERDENA JA~
Subscrìbed and sworn to before me by BERDENA JACOBSEN, this /9 t:I---- day
of~fl /-1 & ,20 CJþ .
WITNESS my hand and official seal.
My Commissìon Expires: m ~ d.-q) I ()
~
,~
1 BETlY MOCEIKA - NOTARY PI.JBI.K:
rOUNTY Of STATE OF
LINCOlN ' WYOMING
My COIfIfAssioo Expires OS/29/1 0
,*-'iÞ-,~~
J:
AFFID4 VIT OF SURVIVORSHIP
Donald W. Jacobsen
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