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Home My WebLink About922134 'ig~ ~ 'E::Iæ ~!b Z~~ ~j~. _c 11:::1 ~ jÞB ,!}I .-'7 1: (\ 000752 Affidavit of Survivorship I, Cheryl Antilla Daughetee, formerly known as Cheryl Antilla, being of lawful age and duly sworn according to law, upon my oath, depose and state: That under the date of September 16, 1984, for valuable consideration, Mamie Antilla, by deed of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on November 13, 1984, in Book 220 of Photostatic Records on Page 930, conveyed Arthur J, Antilla and Cheryl Antilla, husband and wife, as tenants by the entireties, their heirs and assigns, an. undivided one-half (1/2) interest in the following described property to-wit: Township 23 North, Range 117 West, of the 6th P.M., Lincoln County, Wyoming Section 3: S/2NW/4, NW/4SW/4, NE/4SW/4, S/2SW/4 and W/2W/2SE/4 Section 4: E/2SE/4 and SE/4NE/4 Section 10: N/2, NW/4 SE/4NW/4, E/2SW/4, W/2W/2NE/4, W/2NW/4SE/4 and SW/4SE/4 Section 15: NW/4NE/4 Excepting therefrom, the property which was conveyed to Charles H. Nelson and John R. Nelson described on Exhibit "A" attached hereto Subject to the terms, restrictions and conditions set forth in Exhibit "B" attached hereto That by reason of said conveyance aforesaid, the said Arthur J. Antilla and Cheryl Antilla, husband and wife, as tenants by the entireties, became the owners of a one-half interest of said real property, and title thereto vested in them continuously from the date of said conveyance to the date of death of Arthur J. Antilla, also known as Arthur Jacob Antilla, on the 28th day of February, 1996. That by reason of and upon the death of Arthur J. Antilla, title to the one-half interest in the above described real property vested absolutely in Cheryl Antilla. Affiant avers and certifies that Arthur J. Antilla, also known as Arthur Jacob Antilla, is the identical party named with Cheryl Antilla in the aforementioned deed, whose death terminated his interest, title and estate in said real property; and Affiant attaches hereto and makes a part of this affidavit, a copy of the Offici~iI Certificate of Death of said decedent, duly certified by the public authority in which said death certificate is a matter of record. Dated this ~ day of ~06. ~D(ù~ ' eryl Antilla Daugh e I ptate of .ill:p-t II Yc> ; County of U ~~ ) )ss, ) Subscribed and sworn to before me, a notary public in and for said County and State, by Cheryl Antilla Daughetee, this ~ day of~prU_t~2006. WITNESS my hand and official seal. ~n~A N ary Public ~\\\\"tI "'''''''l #\'\~~\NE F1¡;/¡~ §- ~ ~ ...... \S' ~ ff ¡¿'{.o'fARJÞ "cP '%. § {~ mis!onExpires: ~lqJ~ := 1 ," == ~(j)\ 0 ø~ 0::::;. ;.:, ....PUB\.\ ~ ~ 'l. 1"..... . - ~ s ~ ;.~ ......... 0"'11:'" ~ ~III. 0 F '.N'< ~\~ ~IIIIIIII\\I\\\\\'\ RECEIVED 9/5/2006 at 3:49 PM RECEIVING # 922134 BOOK: 632 PAGE: 752 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY ----..---.- - -- --- - ," ,"" ) ~ýâr'" ;!J,I()¡V»........ 1"?/~ '4 J(f.41~ ÿ~.t 000753 EXHIBIT' "A" A tract of land located in Section 3, Township 23 North, Range 117 Nest, of the 6th P.M., Lincoln County, HyoH\iny, described as follows: Beginning at ,the Sou'tl1 Quart<2J: corner, thence N89°50'E, 660 feet, thence NOl02J.'¡"I, 710 feet, thence SB9°50'W, 340 feet, thence NOl021'W, 300 feet, thence N89°50'E, 340 feet, thence NOl021'W,' 224.84 feet, t,J¡enCl~ 889°50'''',660 feet, thence SOl°21'E, 1234.84 feet to the point of beginning, containing 16.368 acres. ALSO beginning at the South Quarter corner of the SE/4SW/4, thence S89°50'W, 905.32 feet, thence N01°21'W, 1234.84 feet, thence N89°50'E, 905.32 feet, thence SOl°21'E~ 1234.84 feet to the point of beginning, containing 25.664 acres. ALSO a parcel of land in the North half of Section 10, 'rowns]¡ip 23 North, Range 117 Nest, of the 6th P.M., Lincoln Counly, Wyoming, more particularly described us follows: Beginning at the North Quarter corner of Section 10, Township 23 North, Range 117 West, of the 6th P.M., Lincoln County, ~~yoIt1i.n9, thence N89°50'E, 660.00 feet; thence f:iOOoOO '4:')"E, 556.56 feet; thence S89°50'H, 1565.32 feet; thence NOooOO'45"W, 556.56 feet; thence NOgo50'E, 905.32 feet to the point of beginning. Said parcel contains 20.00 acres of land, more or less. ALSO a parcel of land in the South half of Section 3, Township 23 North, Range 117 West, of the 6th P.H., Lincoln,County, Wyoming, more particularly described as fol1m'5: Conunencing at the South Quarter corner of said Section 3, 'l'ownship 23 North, Ran<]e 117 West, of the 6th P.M., Lincoln County, wyoming, thence N89°50'E, 660.00 feet; thence N01°21'W, 1234.84 feet to the point of beginning, thence NOJ.021'W, 556.56 feet; thence S09°50'W, 1565.32 feet; thence SOl°21'E, 556.56 feet; thence N89°50'E, 1565.32 feet to the point of beginning. Said parcel contains 20.00 acres of land, more or less. ALSO a parcel of land situated in the 8£/45E/4 of Section 3, '~ownE:hip 23 North, Range 117 West, of the 6 th P. M., Lincoln Count.y, ~'iyoming, more particularly described as follows: Beginning at the South Quarter corner of said Section 3, Township 23 North, Range 117 West, of the 6th P.M., Lincoln County, Wyoming, thence NB9°50'E 660 feet on ,the South line of said Section 3, thence NOl021'W, 710 feet; thence S89°50'W, 3~0 feet; thence NOl021'W, 300 feet; thence N89°50'E, 340 feet; thence SOl021'E, 300 feet to the point of beginning. Said parcel contains 2.34 acres, more or less. <;;:;~:::" ;~r< .·.·1 ¡'Ii: .~'.'.'..'i'I'~.'I'I·'!'; :1 .. " " I>;· .. ~. . . ·~.J'Ú~;;~ ,- q"Þ'~>1 "' ... /" J...À~I'... '.ù'ir 000754 Exhibit "B" The foregoing conveyance is to include all easements, improvements, water rights and appurtenances situate thereon, but specifically not including any grazing permits and rights issued by the Department of Interior and commonly known as Taylor Grazing Rights which include the Dempsy Basin Allotment, issued by the Bureau of Land Management, which grazing permits and rights attached to the foregoing described property and other property. ~. ':;¡:;~i:~~:~:~:%:' . ... .1.:.:. "-'J' '.~ ; .i·"· " , , -:" :j' . ~ - ';:-' , ;-.t~.i;>" :¡:;~;~.;/:;~ ':::.-'\11.:n\};· ....'. :::;:;:}, ¡:;¡r~~; ~ TYPE OR PRINT " PERMNiENT IlLACK INK FOR INS1RUCTIONS SEE HANDBOOK lOCAl FILE NUMBER 1. DECEDENT -NAME FIRST 1004 STATE OF WYOMING DEPARTMENT OF HEALTH CERTIFICATE OF DEATH 000755 lj~~)2%1.~4 J STATE FILE NUMBER 3. DATE OF DEATH (Mo.. OaV, \t.) 4. SOCIAL SECUfUY NUMBER Feb 28 1996 B. DATE OF 8.lATH (Mo., Day, Vr.) 520-38-5973 JlIDe 16 1943 la. PlACE OF DEATH (Check only one} ~ Inpat--'I 0 ER/OutpaUent 0 DOl. QIl::1£B: 0 Nu~ing Home 0 Residenc. lb. FACIUTY NAMe fll not InaUfu'ion, give ,II." wtd ~) ld. COUNTY Of DEATH South lincoln Medical Center 8. STATE OF BIRTH (II not In US-A.. nMJØ ctJUl'Wy) Lincoln 11. M5 ECEDENT EA IN u.s. ARMED FORCES? (Specify... Of no) 13..INSI E CITY 5? (Spec/ly }'ØS 01 no} Kemnerer 14. WAS DECEDENT OF HISPANIC ORIGIN? (SpecU)' no or yes - If )'es, specify CUban, Meklcan, Puerto Rit:øn, Ele,) 15. RACE -AmerlciIR Indian, Black, While, Etc. (Spøclly f 6. DECEDENT'S EDUCATION (Spøclly or;y bIg'-<' ..- ",-'od) Elemeolary/Second.ry (0-12 College (1-4015+1 12 Yes 11. FATHER'S NAME No Yes 0 (Specify) Middle L.ut White 18. MOTHER'S NAME Finlt Mldd.. Maiden Surname Fino' '>, '. ~\"' I 9b. REL.ATIONSHIP TO DECEDENT Jacob William Antilla 18a.INFORMANT-NAME (Type 01 Print) Alice Buck . . 1 H Antilla STREET OR RF,O. NUMBER Souse CITY OR TOWN STATE lIP CODE KerrrIErer 2Oc. CEMETERY OR CREMATORY-NAME 83101 2Od. LOCATION CITY OR TOWN STATE . . Cernete Kenmerer Kemœrer, 23a. Ihe bull 01 nal n and I or invest gallon, n mv opinion al U. time, dale and pace and due to the C8USe(.) ....d. /SIgno... .,., n/Je} ... 23b. DATE SIGNED (Mo., Day, Vr.} th OI;curr.d ~~ iõ Ii ~8 ,. 23c. HOUR OF DEATH 23d. PRONOUNCED DEAD (1.10., DIlly, YrJ M 238. PRONOUNCED DEAD (How) 24, NAME AND ADDRESS OF CERTIFIER (PHVSICIAN OR CORONERlfTfPI Of Prlnl) M Kffi1œrer, 83101 25b. DATE RECEIVED by REGISTRAR (Mo., DIlly, Yr.} March 2 1996 8equenUa1l)l1ie& condiUon., if any,.acing 10 knnMIdiale CAUl" Enl'" UNDERLYING CAUSE (Die..... Œ u...-V lhal InlUallld ....m. IlllIdüng in death) l.A5T ~ I,)-/e í.. u' )'J (071 Lrz~) D~E TO (OR AS . CONSEOUENCE OFI: , Ii /({i (((if )U~ DUE TO (OR A CONSEQUENCE OFI: ApproKlmal8 Itnletvltl Belwøn 10000el and Oealh. , ? : 72 'felL I b, 8 {L'ì (! ¿ IIL"!)¡ Ù..J 7i.7it r,7,I/e, 9' ) JIJ.)( DUE TO lOR AS A CONSE~UENCE OF: d, NoRT U. OTHER SKlNIFICANT COND6TIONS- Conditions "ontrlbullng 10 death but nol relaled 10 eaun given In PART I. ç:) 28. MANNER OF DEATH NIIlur. DPllnding Inwtstigatton 30.. DATE OF INJURY (Month, c.y. Yaw) 30b. TIME OF INJURY 30e. INJURY AT WORK? (SpeeJly ~5 01 no} ....I.'x·: -, VR 2..89 4/94 15M ....... o Could nol be Determined M 30e. PLACE OF INJURY· At home, larm, slreel, laclory, Qtlic. buildlRIJ, .Ie./Specify} 301. LOCATION ISlr..t and Numb.r or Rural Rool. Number, City or Town, Slale) Homlcld. THIS IS TO CERTIFY that this reproduction is a true copy of a reèord on file in Wyoming Vital Records Services, Cheyenne, Wyoming. This copy is not valid unless it bears a raised seal and the signature of the Deputy State Registrar is in red. .,. Date Issued I\.~'·\R dr \ 12 1996 ?~4y~ Deputy State Registrar