HomeMy WebLinkAbout926525
0000:18
AFFIDA VIT TERMINATING TENANCY BY THE ENTIRETIES
STATE OF WYOMING )
) SS
COUNTY OF LINCOLN )
Rosemary E. Ivins, first duly sworn, upon her oath, deposes and says:
1. I am the widow of Anthony H. Ivins and have knowledge of and am
competent to testify concerning the facts as stated below.
2. That I am of adult age, a resident of Star Valley Ranch, Wyoming, and the
Affiant herein.
3. By Warranty Deed recorded March 30, 1977, in Book 135PR on Page 10,
Instrument Number 491238, in the office of the Ex-Officio Register of Deeds for Lincoln
County;Wyoming, ANTHONY H. IVINS, as Grantor, conveyed unto ANTHONY H. IVINS
and ROSEMARY E. IVINS, as husband and wife as tenants by the entireties with rights of
survivorship, the following described property situate in Lincoln County and State of Wyoming,
to-wit:
Lot Eighty-eight (88) in Star Valley Ranch Plat Three (3) as platted and
recorded in the Official Records of Lincoln County, Wyoming.
Subject to Declaration of Covenants, conditions and Restrictions of Records.
4. Said ANTHONY H. IVINS died on January 6, 1993, in Lincoln County,
State of Wyoming, and the official certificate of his death is attached hereto as Exhibit "A".
5. By reason of the death of said ANTHONY H. IVINS, his interest and title
in said warranty deed has terminated and title to the real property conveyed thereby has vested in
ROSEMARY E. IVINS, wife of ANTHONY H. IVINS.
AFFIDAVIT TERMINATING TENANCY BY ENTIRETIES
PAGE 1 OF 2 RECEIVED 2/5/2007 at 11 :29 AM
RECEIVING # 926525
BOOK: 648 PAGE: 18
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
DATED this 12th day of January 2007. O~i;~6S2~)
~"r" r E_ j v ,; $
ROSEMARYE. IVINS
STATE OF WYOMING )
) SS
COUNTY OF LINCOLN )
0000:19
The foregoing instrument was acknowledged before me by Rosemary E. Ivins this
January 12,2007. Witness m hand and official seal. d ~
JACKD.ED~~S-NOTARYPUBLlC ' J¿~) ~
COUNTY OF : STATE OF - --
LINCOLN WYOMING otary Public
MY COMMISSION EXPIRES JAN. 18.2010
My commission expires: dt.- 18, 2iJ{O
AFFIDAVIT TERMINATING TENANCY BY ENTIRETIES
PAGE 2 OF2
O<"\·~L~ ~r'r-
".7 A... 'U.;:) '" ,.)
1;
~ TYÆ
OR PFIHT
IN
PERMANENT
BU'CK
INK
FOR
INSTRUCTIONS
SEE
HANDBOOK
.. .
. ..
a.~~
\'''
~~~
VR2..a9
"',\U J!,;M
000020
LOCAL FilE NUMBER
I.DECEDENT·NAME "FIRST
STATE OF WYOMING
;)EPARTMENT OF HEALTH
CERTIF:ICATE OF DEATH
STATE FilE NUf..aER
3. DATE OF DEA.TH (Mo., Day, VI.,
"'!IDlE
lAST
Anthony
January 6, 1993
e. DATE OF BIRTH {Mo., Day, VI.)
... SOCiAL SF.CURITV NUMBER
March 5, 1 91 9
7.. PlACE OF DEATH (Checll. only one}
~: QMll
o 1~11en1 0 EA/Qulpatten' ODOA
7b. FACIliTY NAME (II nof InS(ltullon. "lie .net IfJd ntmber
o Nuralng Home ~tIdence 0 Olher (SpeCI'y)
1c. CITY. TOWN. OR LOCATION OF DEATH
Td. COUNTY OF DEATH
Lincoln
123 Cottonwood Lane
Southeast of Etna
8. STATE OF EURTH {It not ... U.S.A., name counuyJ
9. MARRIED, NEVER MARRIED,
WIDOWED, DIVORCED (SpecJty)
Married
to. SURVMNG SPOUSE (I' wile, give ngldttn mime)
Utah
Ellen
Rosemary
Roper
11. WAS DECEDENT EVER IN U.S. ARMED FORCES?
f Speclly yes Of no)
12.. USUAL OCCUPATION (Giwt kbl ot worlI' done titling mos'
01 waf"'" NI., wen U reIJf8d
Professor
12b. KIND OF BUSINESS OR tNDUSTRY
Yes
Education
13.. RESIDENCE - STATE
13b. COUNTY
13c. CITY, TOWN OR LOCATION
Wyoming
130. INSIDE CITY LIMITS?
(&peelly t'U 01 no)
Lincoln
Southeast of Etna
Cottonwood Lane
14. WAS DECEDENT OF HISPANIC ORIGIN?
(SpeclfV no Of va. - " ve., apecll1
Cub.n, .....ècan. Puerlo RIc.n. Elc.
15. RACE -American Indian.
Bleck,WI1lIe.Etc.
rSpecJfyl
'6. DECEDENT'S EDUCATJON
ISped" onfy ""'''''''- .........1
Elementary/Secondary 10-12 College (1-40l5T1
12 6
17 FATHER'S NAME
No N. d{ y"O 1"..If,)
Firat Middle Lasl
Mald8n Surname
White
18. MOTHER'S NAME Fil'lt
........
H.
Ivins
Hamblin
Grant
Bertha
19.. INFORMANT-NAME (Twe 01 #'rIA"
t Db. RELATIONSHIP TO DECEDENT
Rosemary Ivins
IBe. MAIUNQ ADDRESS STREET OR R.F.D. NUMBER
Spouse
CITY OR TOWN
STATE
liP CODE
Box
WY
STATE
Idaho
/-/.5- ~:5
6:45
AM
23d. PRONOUNCED DEAD (Mo.. ChlV, Yr.'
23tt. PRONOUNCED DEAD (How)
January 6, 1993
7./:5"
24. NAME AND ADORE5S OF CERTIFIER (PHYSICIAN OR CORONERI(T)oJ)e 01. Print)
Perkes, MD:
25.. REGISTRAR
110 Hospital Lane:
Afton, WY
83110
~
26b. DATE RECEIVEO BY REGISTRAR (Mo., o.y, Yr.)
/-/"1- ~
s .
PAAT I. Enler the d........ I' I, compllcatlone Ihal cau.od dealh. Do nol enler the mode 01 dying. euch .. caldlac
28. or I.....'"y ar"lIIl. ahock, or heert Iallure. U.I only one caUle on.ach line.
IMMeDIAlI CAUSE (Flnm
die.... or condlllon
rellUlllng In de.lhl ..
Approltlmale
Ilnt.,val hlween
lanaal .nd o.'lh.
I
iJf}1 Me(
I
i F fflMd. '
I
!~ V11ð
I
b.
aUE TO(!])ta~aS~ (J .:tx ~ \on
Ccr-./ d-A ~I ðc..C!.lu 7 ( R"r4
DUE TO tOR AS A CONSEQUENCE OF):
~ :JC lQV3 '7 ('!;
DUE TO fOA AS A CONSEQUENCE OFI:
Sequentially 11&1 condlllons,
II .ny.leadlng 10 Immediate
an.... Enter UNDERLYING
CAUSE IDI..... Of Iniurv
"'-I Initialed .venl.
tiNting In ..lhl LAST
d.
PART N. OTHER SIGNifiCANT CONDITIONS-tandillon. comllbutlnQ 10 death but nol relallo to causil gillen In PART I.
Yes
28. MANNER Of DEATH
301'1_ DATE OF INJURY
(Month, o.y, Yo",)
30b. TIME OF
INJURY
30e. INJURY AT WORK?
(Specify res Of no)
lwei
D~ndlng
Irweallgallon
...Idonl
M
30e. PlACE OF INJURV-AI home. I.,m, II...." 'actory.
oIllee t..dletlng. etc. (Specify)
301. lOCATION (Streel and Number or Aufel Roule Number. Clly or Town. Slale)
9ulc1de
-
o Could not be
DeternVned
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.
This copy is not valid
sea 1 and the signature
Registrar is in red.
unless
of
it
the
bears a
Deputy
raised
State
Date Issued
January 19, 1993