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STATE OF WYOMING
AFFIDAVIT OF SURVIVORSHIP
RECEIVED 12/19/2006 at 5:06 PM
RECEIVING # 925476
BOOK: 644 PAGE: 121
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
COUNTY OF LINCOLN
)
) ss,
)
I, WILLIE PACHECO, being oflegal age and first duly sworn, deposes and says as follows:
1. That Cora Rodriguez Pacheco, my beloved wife, the decedent mentioned in the attached
certified copy ofthe certificate of death, is the same person as Cora Pacheco named as one
of the parties in that certain Warranty Deed dated January 23, 1969, executed by Bert Albert
Maragini and Amelia Maragini, husband and wife to Willie Pacheco and Cora Pacheco,
husband and wife, recorded as Instrument No, 414227, on February 27, 1969, in Book 86PR
at Page 66 ofthe Official Records of Lincoln County, State of Wyoming, concerning the real
property situated in the County of Lincoln, State of Wyoming and described as follows:
Parcel 121 of the Town ofDiamondville, Wyoming, as shown upon
the plat thereof dated August 31, 1942, containing 7500 square feet,
more or less. Together with all buildings and improvements thereon
and appurtenant thereto,
2, That I am the same Willie Pacheco mentioned in the above referenced Deed and thereby am
a person interested in the effective property or the title thereto and pursuant to § 2-9-102
W,S. (1980) hereby make the death a matter of record and certify that upon the death of Cora
Pacheco, her previous estate in the property was terminated.
3. That the certified copy ofthe certificate of death indicates that Cora Rodriguez Pacheco died
on March 17,2004 in the Town ofDiamondville, County of Lincoln, State of Wyoming.
Dated this 1'1 day of December, 2006,
w~~
WILLIE PACHECO
STATE OF WYOMING )
) ss,
COUNTY OF LINCOLN )
Subscribed and sworn to before me by Willie Pacheco, this 1'1 Iii day of December, 2006,
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NOTARY PUBLIC
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.'.STATI!OF WYÖ~ING ...'.i
", DEPARTMENT OF HEALTH" '
CERTIFICATE OF DEATH