HomeMy WebLinkAbout927926
OOU:JJ..1.
STATE OF
JJ/Q~
~ 9.Ä1/Y\AX'_~
PROOF OF DEATH & HEIRSHIP
RECEIVED 3/28/2007 at 8:38 AM
RECEIVING # 927926
BOOK: 652 PAGE: 511
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
)
)
)
County of
AFFIDAVIT OF HEIRSHIP OF Mabel Barty. also known as Mabel Catherine Banv. also known as Mable Barry.
, being fIrst duly sworn upon oath, deposes and says:
The she was acquainted with bel B also known as Mabel Catherine B also known as Mable B
also known as Mabel C. Barty deceased for 3 if years;
That he/she is a ..4 ¢1'1..... - . A~) - _ Pc. l.{~".I of said decedent.
That said Mabel Barty. also known as Mabel Catherine Banv. also known as Mable Barry. also known as Mabel C.
Barty died testate on or about the 29th day of June ,_ A. D. 1980 , at about
the age of 76 years.
That the said decedent was not married at the time of death.
That the said decedent was married ð-yL.e.. /
death, is as follows:
time(s), and the name of each spouse, with date of
~
Date of De~lth
Lester A. Barry
November 19, 1976
That the said decedent was not divorced ftom
Lester A. Banv
That the following children of said decedent were living at the time of said decedent's death:
Names
Address
Date of Hirth
Vernon L. Barty
Lois F. Ingelstrom
Barbara Jean Driskell
Now Deceased
,2(
6 I 5 Northland Street, PocateIlo, ID 83201-49 I 5
21032 Fifth Ave S, Des Moines, WA 98198-3629
That the following child
of said decedent died prior to her death, and left heirs as follows
Name
Date of Bitih
Marital SI:atus
Heirs
N/A
0927926
000512
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
AJ!;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 Mabel Barry. also known as Mabel Catherine Barry. also known as
Mable Barry. also known as Mabel C. Barry 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:
Townshio 21 North. Ran!!e 115 West. 6'" 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.
C;~;yJ 4. -dJnêíM-~
Subscribed and sworn to before me this --L:< Ý day of ~f~. 2006.
My commission expires 7-3 -/:;;...
STATE OF .27~~ð
COUNTY OF ßI1AI~~
)
) ss.
)
lic
JOHN B. INGELSTROM I
NOTARY PUBLIC
STATE OF IDAHO
1'/i:~~~)/~:::J:~~~'::;.+
On this ~ay of S1t'J"""'-.¿~ , 2006, before me personally appeared
:;;¡,,. Á L,.e/r~~ , who is known to me to be the identical person whose name is
affixed to the a"ve instrument, and acknowledged the instrument to be J, ¡.J free and voluntary act
and deed.
My Commission Expires:
(- 3-/~
~~
---
+
I' STROM:
JOH~OTARY PUBLIC .
ISTATE OF IDAHO
r " STATE OF IDAHO
O~27926 IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
000513
:~
~
I
I
I
~
I
~
I
~
~
I
,~
~
I
.~
~
.
I
I
~
TYPE
OR PRINT
IN
PERMANENT
'NK
DECEDENT NAME
lAST
SEX
State File No. 2 7 0 7
Local Reg. No. I 'I {r.
Reg, Dist. No. ,.,'-"j 0 .
DATE OF DEATH (Mo., OilY, Yr.)
JUL 21 1"920
State of Idaho
CERTIFICATE OF DEATH
d. TtThi te B.
CITY, TOWN OR LOCATION OF OEATH
>
COUNTY OF DEATH
Female
:-.Tune 29
1980
U. S. A.
!k B. Mar. 23 7.. Bannock
HOSPITAL OR OTHER INSTITUTION Nam. (J(notin øith", øivfltrut.ndnumbør) c;l. 9 u.
k Hillcrest Haven Convalescent Home /
MARRIED. NEVER MARRIED.
WIDOWED, DIVORCED (SpKify)
'D. Widor,,!ed
SURVIVING SPOUSE (If wi'., ,iv. maid,", n.".,.)
15c.
B~RTHPLACE
1>
KIND OF BUSINESS OR INDU3TRY
Ir..HOSP. OR INST. Indicate OOA,
O~/Em.r. ".!p., InJ»ltlert/Specify) I
7d. l.npa1i1ent\,¿1
WAS DECEDENT EVER IN U.S.
ARMED FORCES? (YIII or No)
NOn
IF DEATH WAS aUE
TO OTHEn TtIAN
NATURAL CAUSES,
THE CORONER
MUST COMPlETE
AND SIGN THE
CERTIFICATE
Pocatello
STATE
141.
CITY, TOWN OR lOCATION
11.
USUAL OCCUPATION f IHI' ind 01 work don. durin .' most of
working lif. ~VIJft If ,..iirw11
Housekee er
iHH~**
COUNTY
At
Home
Idaho
IBb. Bpnnock
No.
INSIDE CITY LIMITS
fYn or No)
Yes
,... rlilliam Fenn
16b.
\'¡yomi ng
MAILING AOORESS
'8b 1205 Cherry Lane
CEMETERY OR CREMATORY - NAME
CITY OR TOWN
lIP
Pocatello
Idaho 83201
LOCA nON
CITY OR TOWN
STATE
Ilk Mountainview Cemetery
NAME OF FACILITY
'9d. Pocate110
ADDRESS OF FACILITY
Idaho
DESCRIBE HOW INJURY OCCURRED
2B.
I
I
I
I
I
I
I
I
I
J
I
I
~
I
,ø.....,....""\\\\\""\\\111 ~
/<>" II"III~·
( ~
~
,~
M
"" Pocatel10
Idaho-
221. On the b'lis of ex.minltion .nd/or InveltlQlltion, In my opmloo death occurrød .t the 'line,
dlte and place .nd due to the clulelsl stned.
~c;'::;: ~
DATE SIGNED (Mo., OilY, Yr.}
j'..
"P
.0
õ.a:
EW
.Z
uo
J~
.u
...
HOUR OF DEATH
22b.
PRONOUNCED DEAD (Mo.. OilY, Yr.}
22c,
PRONOUNCED DEAD (Hour)
22d, ON
22., AT
M
{ (I.,
Int.rv.1 "tWein onl,llnd death
\.·<....~O,.
(c
Interval betw..n onnt IfId d..th
Icl
OTHER SIGNIFICA T CONDiTIONS
Conditlonl contributing to duth but not related to ClUJ' given In PART II.'
AUTOPSY (Yes or No)
Ace., SUICIDE. HOM., UNDET:,
OR PENDING I~VEST. (s¡..r:ify}
DATE OF INJURY (Mo.,O.y, Yr.}
HOUR OF INJURY
No
2)...
INJURY AT WORK IY.sorNo}
2711.. 27c.
PLACE OF I.NJURY - AI hom., farm, Itrellt, factory, offIce building.
!;lIe. (Specify)
M 27d.
lOCATION
STREET OR R.F.D. NO,
CITY 01\ TOWN
STATE
27f.
27g.
This Is· a true and correct reproduction of the document officially registered and placed
. on file with the IDAHO f;IUAEAU OF HEALTH POLICY AND VITAL STATISTICS,
FEB 0 ~ 2007.
~;>d~
. JANE S. SMITH
STATE REGISTRAR