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THE STATE OF WYOMING
RECEIVED 7/27/2006 at 3:55 PM
RECEIVING # 920666
BOOK: 627 PAGE: 785
SS. JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
THE COUNTY OF LINCOLN
----.- - -.-- --- ---
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AFFIDAVIT TERMINATING ESTATE BY THE ENTIRETIES
I, BarbaraA. Chapman, being of lawful age and first duly sworn according to law, upon
my oath, depose and state:
1. That I am of adult age, a resident of Thayne, Wyoming, and the Affiant herein.
2. That by virtue of the conveyance which is recorded in the office of the County
Clerk for Lincoln County, Wyoming, located at Kemmerer, Wyoming in Book
152PR on page 525 is recorded a Warranty Deed. The Warranty Deed, dated
the 16th day of January, 1979 conveys unto Comer C. Chapman and Barbara
Chapman, as Husband and Wife the following describèd property, to-wit:
Beginning at a point South 98.2 feet from the North Quarter Corner of Section
23, T34N R119W of the 6th P.M., Wyoming and running thence East 279.0
feet, thence S 0°05' E, 259.9 feet, thence S 89°45' W, 239.8 feet to the East
right of way of U.S. Highway 89, thence Northwesterly along said Eåst'right of
way of U.S. Highway 89 to a point 100.4 feet South of the point of beginning,
thence North 100.4 feet to the point of beginning.
3. That by virtue of the conveyance which is recorded in the office of the County
Clerk for Lincoln County, Wyoming, located at Kemmerer, Wyoming in Book
413PR on page 1 is recorded a Warranty Deed. The Warranty Deed, dated the
4th day of June 15, 1998 conveys unto Comer C. Chapman and Barbara A.
Chapman, as Husband and Wife the following described property, to-wit:
Lot 11 of River View Ranchettes Subdivision, Lincoln County, Wyoming.
4. That by virtue of the conveyance which is recorded in the office of the County
Clerk for Lincoln County, Wyoming, located at Kemmerer, Wyoming in Book
564PR on page 487 is recorded a Special Warranty Deed. The Special
Warranty Deed, dated the 10th day of August, 2004 conveys unto Comer C.
Chapman and Barbara Ann Chapman, as Husband and Wife as tenants by the
entireties the following described property, to-wit:
Lot 10 of River View Ranchettes Subdivision, Lincoln County, Wyoming.
5. That said Comer C. Chapman, aka Comer Cranney Chapman died on the 27th
day of January, 2006, and a copy of the original certificate of death, certified
to as true an correct by public authority in which the original of said certificate
is a matter of record, is attached hereto as Exhibit "A".
6. That by reason of death of said Comer C. Chapman and by reason of § 2-9-1 02
W.S. (1980), the decedents interest and title in said conveyance has terminated
and title to the real property conveyed thereby has vested absolutely in Barbara
A. Chapman, aka Barbara Ann Chapman continuously since the death of the
said decedent.
FURTHER AFFIANT SAYETH NOT.
Dated: 7- ~ 6· ð¿,
r3~ fi ~~
Barbara A. Chapman
Iy
0920666
C00786
State of Wyoming
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County of Lincoln
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The foregoing instrument was subscribed and sworn to me by Barbara A. Chapman this
day of ~ ' 2006.
Witness my hand and official seal.
My Commission Expires:
~ H. ëJ ~bliC
6- ;;:20- ~ð() 7
JIll.. H. LARSON - NOTARY PUBLIC
OOIJNTY OF
IJNCWJ
MY COMMI 80
mTe OF
W'1QMING
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STATE OF IDAHO "~~~[;'!I['::'/""')¡:':";:'>"
IDÁHO DEPARTMENT OF HEALTH AND WELFARE ,;:,'Oi) 0 t7 8 7,\::1:
DATE Fm.v S;~TE REGISTRAA: BUREAU OF HEALTH P:a~~:~d:h:D VITAL STATISTlCS.,;~' ~i~F'.\'~' ",,:,i:i~~\:;~\,,:;,I:!::
CERTIFICATE OF DEATH STATE FILE NO. '. ':;,a~"" ," ,),,/':c,: " ':
~~:::l.T=.u.~~:ci~E=::;rt'::~~:GJ~~~~::::~TI~~~~,=~=~IoIIE l~I·R~g. ~¿~::"-:-I I ~"'. ·-iJf 1-",~~;,¿,~}'m-~~~ '::~~.
* 1. DECEDENT'S LEGAL NAME (Include AKA'slr any) (First. Middle, Lasl, Suffix) r' sex . '13: ~OCIAl SECU~Ir:r NUMBER
'. " 'I" I,'.:"
'-~~"':I'F2 Comer Cranney Chapman ' male 'S20-30-463Q"~'"
rERMAN£,., -4:1 AGE l¡!lsl Birthday 4b UNDER 1 nARI 4c UNDER 1 DAY 5 DATE OF BIRTH (MoIDaylYr) f. .. If\THPLA,CE l~it,Y and State. Tern, ",.11""': " Of FOre¡~" n, ,.country)
:Q~~ ~~ I,;:~~ 'r,_t4wh1 ~ þa)1 I Hoúrt I MW\uIu I
".n."H ,/1~4 (Y'.", "" ) '.." October 25, 1931 Afton. Wyoming)
fOR - :-:- 5 la, m;:SIDENCE_.... STATE OR fOREIGN COUNTRY1'b COUNTY 1c. CITY of'( TOW~\:¡"
INSTRUCTIONS ~ li~r . ",._,\\..':,:-/:
"...~:~o.s CI W'yoming"(:",>"" Lincoln ' Thayne'·.',."';" ,,'
1.-: - - ~ 7dLSTREETANDNur¥UI~R 7.. APT. NO., 7\,~PCq.,,~E,. '.ra, INSIDE CITY
, . , , > I:>-;C "\ \ LIMITS?
~ -'. c, ~ 379 Fidler Lane ,,': 831::!7."',:, " .: Dves XlNo
Z·· 'g .. MARITAL $!ATUS AT TIME OF DEATH I"· ~SP~US'f'S NAME (II 'r'!e. gI¡emaidenna~),::: " " <" .'
f; . ,~ "II" '.. I/I.,,!' : . 'i" "1:' .h¡:I:~'I,'i,"
:,-':>', ',-- ~ ~ ~Married dMaff/ed,but.epaTaled OWldOWflS OO¡VDfCed ONev¡rrtnarried OUnknown Barbara Ann Van Nay 'I,'. ,I, ii' I,' ,:
~ .!! 1Q EVER IN U S 1h, FATHER'S NAME (Firsl, Middle,lasl Sumx) -~ ~:'BIRTHPlACE (Slale, Territory, or Foreign Ccunlly),
g¡ ~ ~~~~~?;, John Toliver Chapman! Texa~'j""~; a-~:";:'I',-
:E; 1ð Ves -~': 12a MOTHER'S ~PEN NAME (FIrst, Middle, last, Suffix).<_,- 12b. BIRTHP~AÇ~ (St~e, T nlry)_ _
~ D No '" Donna Cranney·, , . I'Wvomi~;~~,o'h .~
:i 13I,INFORMANT'S NAME (T~ or' print)--. '3b RELATIONSHIP TO DECEDENT ruc MAll~G ADP~SS (Street a~~._:~trÐer,£~y, ,Stale, Zip Code
~ Barbara Ann Chapman wife P.O. Box 638' ThiYne WY 83127 ~( Bit;'
8 * 14, METHOO OF DISPOStTI~ 15. PLACE OF OISPOSlTtON (Name and address of cemelery, * 11 NAME AND ~ ADqij~SS ~F FUNERAl, FAGIU!yt~ _.> ,~<:¡;~,J-'- ,
~Burial _.OCremabon CfemllICly,otherplac:e) Schwab Mortuary.",-:._-:::~;r --£..,. :,_:_ _. ~
~::::;:;f'om .'hoDEnIO<Tbn-.nl Etna Cemetery, 44 East 4th Avenu~"
DOIh..(Spe9f.n Etnª, Wyoming Afton, Wyoming 83110 ,
. 1'~: S,IG}#AT~~ ~ F~NERAL ~~ICE ':>~~ OR PERSON ACTING AS SUCH 1* 11b. LICENSE NUMBER (Of licenseel 1.. WAS CORONE", CONTACTED?
. --:t::z¡.q (&I '-;f. ,_.t 1 M - 676 D Ves III No,"
I I PLACE OF DEATH (1g·22
:~t~;::T~I~C~:~t:ij~A H~~I~~: :~~~~:C~~;I~ ~~u~:~ S=;~~~~:~~a::N ~OH~;::;:s home ,0 Other (Sped(Y{\,: ¡ , ':
* aO. FACILITY NAME (IfDm facility. give slreeland number) r* 21. CITY, TOWN, OR LOCATION OF DEATH, AND liP C~D~ * 22. CO,UNTY OF DEATH
Eastern Idaho Regional " , ::,'
. Medical Center Idaho Falls 83404'::"::' " Bonnevl1le :::,1 ,
* 23. DATE OF [?E~.T,H (MoJDayIYr (Spell month) r2~. TIME OF DEATH, 125. DAT~ PRONOUNCED 0\ (MoIDaylVr) (Spell ~I.h~ 21: .~ME PRQ~Q~~~~,~,:~,:"'D I"{~' .
,.',,, ,february 27, 2006 0005 (2.",,1 February 27, 2006...1" boos '1,[' '(24t><1 1':,:,';-
',:¡ ,.' 27, CAUSE OF DEATH
PAIn I. Enler!he ~ - diseases, InjUfles, or corrøticaUons - thft direc1ly caused the death. DO NOT enter terrnnal evenls such.s cardiac I Approximate Inlerval:
afTI!.sl, respiraloc:y a"e~1. or venlrtcular fibriUaUon withoul shewing the eUoIogy. 00 NOT ABBREVIATE. Enter enly one cause on a line: I Onsello Death
IMMEDIATEÇAUSE(Fh",1 roe ~ 'PI (' '< fÒ/'ì Çc.'( lvr-€.' !,' " :, ~ ,ðq't~
,"~~:~¡::~~::~Œ:s,:; L~Ep(Õ·'-·"-7' "«""'<'"'' ----\_ I,' :.'I~~J
'~?:';:~ if8ny,lead¡ng.lothe~use OUE TOlarp uon...u...c.qf): ',_._ . _' 7 .,.'
:.r:: ~s~~~~LI~~~~::~~EÌh'. ~:' I -. ..-i;-<_"-:., : j::'!',
œ lAST'(dlseaseotlnj\Hy .~ PUETO(orl'lconleqlletlCeoq: ,.- ........,.:::' ,'" I '. ':;1"
.- ~-.4) IhallnlUated the event. . ."."'. 'i', _:'
_.__.!: resulting In death), -.--,- d. I
;...¿i. ': ~ ~ PART U. ~nter. other s~ctn¡ficanl conditions contribulmo to death bul nol resulting In the underlying cause glvenïn Part I 21a. ~::F6~~~~~PSV ~2Ib. ~V~~B~~O:;~~I~~~~~:
~ ~ Id-t-~ km;r,. / ' .'. ' : THE CAUSE O,F OEAT!:t?
LL N 21. PID TOBACCO USE 30. IF FEMALE IAged 10.5~.: 0 Yes ':". iO NOI ", '! tJ Ves '::: '0 NiI!;;' :" ::
¡:: ~ .' CONTRIBUTE TO DEATH? 0 NoC pregnaol Wllhin past year 0 Not pregnanl, but pregnanl 43 davs n,I)~
~.~ r'.Dy....",~P'ob..I' \ ~:::::~::,~p<~:nl' D~::::·:.~::I:..nlh.p.sI "~:;:"I~FDEAi;~:'InV.''.\9'hon'"·'''''
.!!\'D ,~~ \,.~~..-¡rU!'~ .!":" Within 42 days of death . ,- year 0 SUICIde -_ CJ :CÇlUldootbe d~ ermned
,,' .: '" 'ì 1 i;p~t~?~{~~I~~~D1:sr!\ '" TIME OF INJURV (24J~:~~~'~~~~~;¡~~::~~;: ~_. r...'m,...~eet, , ~J:':'~ co. D N~
31. lOCATION 9F ~~JURY: .'. -- Siále . - '. '.., CilylTO'M1 or County '::-.' /'i:f
." s~:~andNÛ~er-orlocallon' -..~. -.'" " ...:'-- Ap;~ntNlJt'ti)èr -_
',7:~~~g~I:~~?¿1.~~I~~~~~~~~T ~c~~:6~~:;'~~~NJURV,STATE THE TVP~(SI OF VEHICLE(S' INVOLVED (AUIO~"e'~'~':;;~"?lorCYd.. AlV "~·i'l'), '...D"'-¡
.. ".1"':' " )
'..., "":".. TRANSPORTATION I''", WAS DECEDENT. U Drrve</o""'lor U P....ng.' ,"., WHAT SAFETY DEVICE(S) DID DECEDENT USE/EMPLOV?
" INJURV ONLY 10 Pedestrian OOlher(Soedfv) I 0 Seat bell 0 Child safely seat 0 He-'met,,-_.O Ãirbag 0 N9'lê;,-~·ö Unknown r,t;~f~~i~{C~C"" .. <,
I~~: CERTIFIER (CheCk only ene. based on official capacity fer this certificate) . 39!;t. LI~E~S_e.~UMaE~_ ., ~_:.::"-<;'_. <I'~::';' <--~
XI PHYSICIAN - To the besl of my knowledge. death ocCUfTed 81 the Ume, date, and place, and due 10 the!!JjJl!Jl cause(sVmanner slated_ I'M .õ. - ~ ,t ,'_:; - . ,,::-:'.: I. 1:;1:' ::~~~:~:
o CO!tONER· On Ihe basis of exa~nall: a~dler In;;Stl~icn, In my opinion, dea~ allhe I~me, date, and place, and due 10 the f39Zö.-¥- \EO ,.-,?, :'- ". I"', :;" ,:¡,_, ~~/':;';:¡:::>:!I'!<', :';::
SI.:~:::~~n:,::~e~:: ~~:,"; ~~ . '¡\" 1':D1S~~~Z~~~I\";""I"'~
* Jld..NAME, ~ØPR~SS,IAND, liP CODe OF CERTIFIER (Type crprinl) ..l:~',,~,: I ''''!"":,,,,;/:!!:;).'.; ,.::':">..:'.:":
William E. Armour M.D., " 2001 S. Woodruff Avenue' Idaho Falls Idaho 8 ., . ::" "
~Oa.,CQ~ONER'S.SUB~EQUENT SIGNAl~RE IF NECESSARY: The corone . signature in Ihisitem supersede. that of Ihe phys;dalJ¡ ~_ ~Ob.I?AT~ SIGNED_ r: I <.1
"I,,~~ lh.ccron"'be(:omes,.~ecer1lnercf(eccrd_, ,~,,' .. .".... ,'t i~JL.:'::- .h·'·'::'t"''''''J~~
rtia~eir~Viewedandtr~œ'ssaryamendedthernedlcalseclion" "".,. .-. ~>,
'.' -41~.~,;R,EGISTRAR'SSIGNATURE ~ ~ ~ ':!;:jì~'" ~}b.D~te~IGNED --0-",,-,
.;".,.:,,;,~.; 'pi f-'. 1\ Q [0 '~I\~ 1'- 03.":¡02. Ç¡
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IFDEATHW~
DUE TO OTI1E11.
THM NATURAL
,. CAUSES,
THE CORONER
I01U
CgMPLETE AHO
SIGN THe
',:::11 " CUTIF1C.U;;,
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.:~- .. his 1S a true ard-correct reproduction of the document Qfficlally registered and ptaced
_ the IDA':!9BUr:,~~~BfHEALTH POLICY ANO VITAL STATISTICS. "
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displaying stat eal and sign~!ur. of the Registrar, ,
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STAlIISTICAL INFOR"'ATION
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