HomeMy WebLinkAbout925923
000756
AFFIDAVIT OF SURVIVORSHIP
I, DONNA LEE DACHTLER being duly sworn under oath, states as follows:
1. CALVIN LEE MCFARLAND and I are the record owners, as tenants by the
entireties, of property in Lincoln County, state of Wyoming, pursuant to a Warranty Deed that
was recorded in Book 531 PR at Page 712 on August 21, 2003, as Instrument No, 892692; said
property be~ng more particularly described in the Deed attached hereto as Exhibit A.
2. CALVIN LEE MCFARLAND died on March 29, 2006. An original copy of the
Certificate of Death for CALVIN LEE MCFARLAND is attached hereto as Exhibii. Band
incorporated herein by reference,
3, I am hereby requesting that title to the above property be, by the recording of this
affidavit, vested solely in my name: DONNA LEE DACHTLER
DATED this 2- day of January, 2007.
~0-1'2~ ~ kQwctl~ ,-
D NNA LEE DACHTLER
STATE OF WYOMING )
) SS,
COUNTY OF LINCOLN )
ON THIS, the S day of January, 2007, before me the undersigned, a Notary
Public, in and for the State of Wyoming, personally appeared DONNA LEE DACHTLER , who,
under oath, signed the above Affidavit of Survivorship, and acknowledged that the statements
contained therein are true and correct to the best of her knowledge, information, and belief.
IN WI1NESS WHEREOF, I have hereunto set my hand and affixed my official seal, the
day and year in this certificate first above written.
JACK D, EDWARDS - NOTARY PUBLIC
COUNTY OF STATE OF
UNCOLN WYOMING
MY OOMMISSION EXPIRES JAN. 18.2010
My Commission expires: ~
~J;¡~
NOTARY PUBLIC
RECEIVED 1/9/2007 at 1 :57 PM
RECEIVING # 925923
BOOK: 645 PAGE: 756
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
.$'--- --_.~-~\~I"~
,', -:. :..'.... '.
:\ ;:.:::: '{ "::::." :~< .::: :~:: ;:; /' :,
STATE: OF WYOMING'
{DÈPA~TNiE~T OF~EÂL1fH
1Ft 1.
.. ....
... .. .
... ..'
ST~t.. OF W'f4MING:
DEPARTMENT OF HEALTH
CERT1FICATE OF DEATH
.. . ..
,\
n90Q
~OCAL FILE NUMBER
1.DECEOENn_~L~I!~MA·.'~(FInt.MId~~~.
CBlvin Lee MëFar:1and
4.IiOCtAL IEDJRrrY NUMBEJI
/
STATE ALE NUMBER
~,"",","'.M'., :1Ia":':r""ch~J:"-""'\""'-!
)29, 2006
e. DATE OF umt ~JM)
,~
"r':AUroP8Y~~~~IlE~~Lm~(7EOfr~,
2!.IF I'!h¥.U·:.\G:!01Ö~. ,,/'
o HaI~,...,....... ,.,..,. 0 Nee P"'IMÑ, WI,....".,. 43 ...,.10 1 ,... It..........
D',.....,..tllfneor........ " O"",,-,If......-WItmIMPIllly.r
DNatP.........buI.......~'G~ar......·· . '., ........ .... ..,
;10. DArE,OF INJURY ~ NI ,
03fl9f.2006
Vehicle rolled over and driver was ejected.
37.. CEftTlMR (a.dI;..., OM)
,.,g=:~~::~..==~;:~~~::;::;,-:::..~~~-::.t;:t:;e~~-4~~~:;;;....,