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Affidavit of Survivorship
I, Clara M. Dayton, being of lawful age and duly sworn according to law,
upon my oath, depose and state:
That under the date of March 5, 1956, for valuable consideration, John
Dayton and Goldie Dayton, husband and wife, by deed of that date, which deed
was duly filed of record in the Office of the Lincoln County Clerk, on March 16,
1956, in Book 16 of Photostatic Records on Page 43, conveyed to Willard E.
Dayton and. Clara M. Dayton, husband and wife, the following described property
to-wit:
Lot 1 of Block 19 in the Town of Cokeville, Lincoln County,
Wyoming
That by reason of said conveyance aforesaid, the said Willard E. Dayton
and Clara M. Dayton, became the owners of said real property, and title thereto
vested in them continuously from the date of said conveyance to the date of
death of Willard E. Dayton, on the 17th day of April, 1990. That by reason of and
upon the death of Willard E. Dayton, title to the above described real property
vested absolutely in Clara M. Dayton. .'
Affiant avers and certifies that Willard E. Dayton is the identical party
named with Clara M. Dayton 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 Official Certificate of Death
of said decedent, duly certified by the public authority in which said death
certificate is a matter of record.
Dated this oft day of ø d~06.
(f/fUer q. ~1'~
Clara M. Da on
\
State of~6
County of1; nl' ~Yl
)
)ss.
)
Subscribed and sworn to before {!1e, a notary p,ublic in and for said County
and State, by Clara M. Dayton, this ~ day of ~ , 2006.
WITNESS my hand and official seal.
~ iJ1a~~J ~
Notary Public
My Commission Expires: CtJ. Þ, é)07)~
RECEIVED 1012712006 at 2:39 PM
RECEIVING # 923796
BOOK: 638 PAGE: 357
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ALIA MARIE WATHEN
Wyømlng
Notary Public, County of Lincoln
My Commission Expires
October 12, 2008
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000358
TYPE
OR......T
..
PERUANfNT
N<
FOR
INSTRUCnONS
SEE
HANDBOOK
LOCAL FLE _ 100
,. DECEDENT-NAME FIRST
STATE OF WYOMING
DIVISION OF HEALTH AND MEDICAL SERVICES
CERTIFICATE OF DEATH
qO-OOq3~
WILL:\.RD
... SOOAl SEClIVTY NJWIEA
520-12-3614
uu
Sf... TE fl..E NlIMBf.R
1 DATE OF D£ATH{oWo., Day. V,.,
April 17 1990
'.DATE0f'8lATH(Mø~ D~. Yr.)
Fobruary 2 1?17
HOSPITAL; D..... 0 ERlOutpaliMI 0 DOA ~
7b. FAQUTV NAME. (II not in.,/tufioll, gilfe .,,... end tunÞ.,.)
7a. Pl.ACE OF DEATH (CHc:.t ønI'I OI'UIJ
o ,......,-bM II R.sidMce 0 OU- (S".mly J
7r::. CITV, TOWN. OAlOCATION OF DEAnt
1d. COUNTy Of' DEATH
31S Sa:;e St.
I. STATE Of BftTH (It nøt '" U.S.A. nMN COUfI1rrJ
Lincolr¡
Iùaho
11. WAS DECfO£NT EVER IN u.s. ARMED FORCES?
¡Specify r-. Of no)
Yes
I. MARRIED, NEVER MARRIED. 10. SlIMVWG SPOUSE {If wu., ,w. maiden n_J
WIDOWED, DMJRCED (Sp.cìt, J
Harried
12b. KIND OF BUSINESS OR NJUSTRv
1~. PllESDENCE-STATE
13b. COUNTY
12a. USUAl OCC......T1ON (Give kind 01 .-crk tJatw dKint moM
01 _k/ftg' til_, ....., " "'¡'«IJ
Water Supervi::;or
13c. CtTY, TOWN OR LùCAT10N
Ci t:/ GO'lernm;:mt
YI~.roll1inß
13e.1NSiOE CITY UMI1S1
(S Mdly yell III no)
Lincoln
Yes
t,¡gÎXI Yes 0 (Spec;fyJ
~ Llllil
,... WAS DECEDeNT OF "ofSPANIC 0A\3I047
(Specify no CI yea.. ,.e. 1pftM~
~ MniC'''''~kJAicM,EIc.I
Cokevi110
11. FATHER'S NAME
....
Marvin Moroni Dayton
'''' IN:'OAUANT -NAME (Type or Prim)
Michael L. Da ton
Schwab JAortuary
, death DCCUfed II &he Iimt, ... and _. Md 1M
Cokevi11e Cemeter
21b. NAME OF FACUTY
~. :;{3c,
~---.
~êf '
OIJ2:fl-'~
Ih. r'~_..... .
III......,..... _.c~~.
.ti
I~!
~;
22d.NAME OF ATT£N)NJPffYStCtANFOTHEII THANCERT1fEII ffy,. IN Ptint
22e. HOuR 0# Df.ATH
......TI cu. fFinII
-..-
,..... in dlldI) +
..
Cardio-respiratory
CUE TO (OR AS A CONSEQUENCE OFI:
Diabetes Mellitus
DUE TO lOA AS A CONSE:CUENCE OF):
~liIIcondllana,
I WIV,IMding to ........
~ EnIø u.eaYl"
CAU. (DIu... or rpy
.n.cinllit.d evenl.
re.... in dealh) WT
DUE 10 lOR AS A CONSEQUENCE OFI:
d
PUtT I. OTHER stGNF1CANT CONDIT1ONS~ ccnriNAing 10 ....,.... noI; tU*I Ie t:.....,... in PAAT I
¡,i'
H. MANNER OF DEATH
No.... Op_
~;~~~ - brftliglltian
VA 2-89 """"'" OCø..*lnacDe
1/89 15M -
--
30&. DATI Of IN.AJRy
11tIon,,.,, 0.... r..)
3Gb. TNE OF
"JURY
M
3Oe. PlACE OF IoIJlJAY -AI home, linn...... lKtoty,
ane:. ...... ... {$pei'"
Sar,e St.
.'- DECEDENT'S EDUCATION
{S".ci{y øttIy high.., f Tadø cDmpIIJllId
V~hi te
-r
(0·121 CoIqa 1t·1I CI S +)
18. UOTHEA'S NAME
,-..sl
.......
Maiden Sum.ne
Alice Rebecca Bird
11b. AEl.AT1ONSttP TO DECEDENT
Son
STA"
ZFCOD£
82901
2Od.lOCATJON
CITY OR TOWN
STATE
Cokeville \'Iyamin
...... 21e.. ADOAI:SS OF FACUTY
45 83110
:g
M Ii
éJ~ 3Ô
M
~ni~JLl Wm Fogarty. MD)
25b. DATE AECEfVED BY REGISTRAR f~ D." Yr.)
5- -:?-9'O
I ==:..n
I 0nMt and o.ath.
I
:immediate
.
,
: months
I
I
I
,
3Oc.1N..Il.WW AT Y«JAK7
($p«:Jly ,.. fII (to)
3OllOCA11ON ...... andNumMr or...... Aaute....... 1..:11, 1;11" Town, Slate)
THIS IS TO CERTIFY that this reproduction is a true
copy of a record on fi 1 e in Wyomi ng Vi ta 1 Records
Services, Cheyenne, Wyoming.
Th is copy is
sea 1 and the
Registrar is in
Date Issued
June 5, 1991
not valid unless
signature of
red.
raised
State
it
the
bears a
Deputy