HomeMy WebLinkAbout925050
000246
PROOF OF DEATH & HEIRSHIP
STATE OF
Arizona
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RECEIVED 12/6/2006 at 9:50 AM
RECEIVING # 925050
BOOK: 642 PAGE: 246
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER,
County of
Maricopa
AFFIDAVIT OF HEIRSHIP OF Gwendolyn Williams, DECEASED.
fOJ{AJ 1-1. ('/IR TER. , being first duly sworn upon oath, deposes and says:
The he/she was acquainted with Gwendolyn Williams deceased for ~ years;
That he/she is a SON / AI ¿ /I W of said decedent.
That said Gwendolyn Williams died testate on or about the 19th
,_ A. D, 1991 . at about the age of 86 years,
That said Gwendolyn Williams was a resident of Churchill County, State of Nevada at the time of her death.
day of
December
That the Last Will and Testament of said Gwendolvn Williams was not flied for probate.
That the said decedent was not married at the time of death,
That the said decedent was married
death, is as follows:
2 (two)
time(s), and the name of each spouse, with date of
Name
Date of Death
Roy Rizzi
Albert Brinley Williams
Unknown
November 26, 1972
That the said decedent was not divorced fÌ'om Albert Brinley Williams
That the following children of said decedent were living at the time of said decedent's death:
Names
Address
Date of Hirth
Nonna 1. Petersen
Now Deceased
Judith A. Carter
6528 W, A venida Del Rey, Glendale, AZ 85310
8-1-1942
That the following child
of said decedent died prior to her death, and left heirs as follows
Name
Date of Hirth
Marital Status
Heirs
N/A
'C\"'r'jll'Ii·}
OJ tt.. ,...:~ 'U ~.~: \.
000247
If decedent left no surviving children, give the following infonnation:
First: List parents, if living; also list brothers and sisters; if any brother or sister died before decedent, also list his or her
children. Second: If no parent, brother or sister survived decedent, list the following if any surviving: grandparents,
nephews and nieces; uncles and aunts; cousins; if none of foregoing survived, list nearest of kin surviving,
Names
N/A
A~e
Address
Relation to Decedent
That all of said heirs at law were and are of sound mind, and that none of them are incompetent.
That all debts and claims against the estate of said Gwendolyn Williams were fully paid and at the time of her death she
was the owner of or had an interest in the following described real estate, to-wit:
Township 21 North, Range 115 West. 6th p, M.
Section 36: All (also described as Section 36: Lots 37, 44 and 46), less and except the railroad right of way
Further Affiant saith not.
-JLII ~
Subscribed and sworn to before me this
.r;ff
c/l S' day of
My commission expires
/alr/o r
I
.
STATE OF ~~
COUNTY OF ~~
On this c:<. Sday of --2JJ ~ ,2006, before me personally appeared ";-Od ~
(! #- R T EÇ 1:: , who is known to me to be the identical person whose name is
affixed to the above instrument, and acknowledged the instrument to be free and voluntary act
and deed, 8 KERRY 08&11..-..
NOTARY PUBLIC - ~
. MARICOPA COUNTY
My Commission Expires: M~ Commission Ex ')ires
December 14, 2009
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I~¡;¿or
fROLL 75
IMAGE
179
DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH
VITAL STATISTICS
STATE OF NEVADA - DEPARTMENT OF HUMAN RESOURCES 000248
DIVISION OF HEALTH - SECTION OF VITAL STATISTICS
I CERTIFICATE OF DEATH I 010411
4
Middl. L.sl DATE Of 9EATH (Moeth, DaV, Y....)
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TYPE
OR PRINT
IN
PERMANENT
aLACK INK
LOCAL FILE NUMBER
DECEASED-NAME First
1.
CITY, TOWN, OR LOCATION OF DEATH
Gwendol
WILLIAMS
2,December 19,1991
HOSPITAL OR OTHER INSTiTUTION Nam. (If not etther, give street and numbør)
IfDEATIi
OCCtJRRED IN
::::mnm:::
SEE HANDBOOK
REGARDI'/G
-'!;vMFi.c ïiúN Ci
RESIDfNCe ITEMS
3b, Reno
RACE-¡~d~~n~~~j(:þ:~Íyfm.rican
5. Whi te
STATE OF BIRTH
(if not U.S,A., name counlry)
3c. Washoe Medical Center
~
13,1 520-16-2079
RESIDENCE-STA TE
Firat
Middl.
INSIDE CITY LIMITS
(Specify Yes or No)
15.. No
LaSI
15a, Nevada
FATHER--NAME Firat
15d·l080James Ln.
William
NAME (Typa or Print)
Ellen J.
(Str.et or R.ED. No"C1tv o~ Town, State, Zip)
Davis
Norma Peterson
BURIAL, CREMATION, REMOVAL, OTHER (Spectfy)
1080 James Lane
Fallon, NY. 89408
City or Town
Stat.
./3/
rkSMemorial -
Reno Nevada
414 12th Street
S rks, Nevada 89431
22e, On the basla or exemlnatlon dlor Investigation, In mV opinion death
>- .< 8nh~ time., date and place nd due 10 the cause(s) and manner t
~1! (S~natuieand Titte) ~
]15 DATE SIGNED (Mo., Day, r,)
E8Q.-~December 20, 1991
c 221). 22c.
"i2
.D.3 PRONOUNCED DEAD (Mo" Day, Yr.) PRONOUNCED DEAD (Hollr)
~ .December 19, 1991
2td·'22d. ON
NAME AND ADDRESS OF CERTIFIER (PHYSICIAN,ATTENDING PHYSICIAN, MEDICAL EXAMIN!=R, OR CORONER), (Typa or Print.)
0940
22e. AT
0940
LICENSE NUMBER
CONDITIONS
IF ANY
WHICH GAVE
RISE TO
IMMEDIATE
CAUSE
STATING THE
UNDEHL YIN(;
CAUSE LAST
P.Ö.Box Injo, Reno, Nevada 89520 23b.WCC s. 35
DATE RECEIVED BY REGISTRAR (Mo" Day, tr,) DEATH DUE TO COMMUNiCABLE DISEASE
1991 24c. YESD NO[K
Intervel b.tween onsel and death
FAn'f
I
Cd)
Atherosc},e"totic heart
DUE TO, OR AS A CONSE~UENCE OF:
failure
L. i'~' () I
Interval between onset and death
DUE TO, OR AS A CONSEQUENCE OF:
Interval between onset and death
PART
Ii
c
OTHER SIGNIFICANT CONDITIONS-Conditions contributing to death but nol resulting in the underiving ceuse given in Part I.
AUTOPSY
(Specify WAS CASE REFERRED TO
Yes or No) CORONER (Specify Yes or No)
27, Yes
Renal failure· sepsis
ACC" SUICIDE, HOM" UNDET., DATE OF INJURYfMl,Q,¡t, ItJ
OR PENDING INVEST,
(Specify)
28a.
INJURY AT WORK
(SpecilV Yes or No)
28..
28. NO
HOUR OF INJURY
DESCRIBe HOW INJURY OCCURRED
28b, 28c,
PLACE OF INJURY-AI home, fann, street, factory, offICe
building, ate. (SpecIfy)
M 28d.
LOCATION.
STREET OR R.F.D. No.
CITY OR TOWN STATE
281,
28g,
$1'#\ TE REG!$TR~,R
No.032776
144545
CERTIFIED COPY OF VITAL RECORDS