HomeMy WebLinkAbout928433
000523
A FFTDA VTT
The State of Wyoming )
: ss.
County of Sweetwater )
Gloria Sempsis, of lawful age, being first duly sworn upon her oath according to
law, deposes and says:
1. That she is the duly qualified and appointed Personal Representative of the
Estate of Robert L. Rayback, deceased.
2, That Robert L. Rayback and Margery M. Rayback were married to each other
on the 19th day of June, 1947, and from that time, until the death of Margery M. Rayback,
were husband and wife.
3. That Margery M. Rayback died testate at Afton, Lincoln County, Wyoming,
on February 11, 2006.
4. That on the ih day of September, 1965, Robert L. Rayback and Margery M.
Rayback, husband and wife, purchased the following described real property from Isabelle
McCoy, a widow:
Commencing at a point which is Ten (10) rods East from the Northwest
Comer of Lot Two (2) and Block Nineteen (19) in Afton Townsite and
running thence South One Hundred (100) feet; thence West Sixty (60) feet;
thence North One Hundred (100) Feet East Sixty (60) feet, to the place of
beginning, together with improvements and water-rights.
5. That Isabelle McCoy, a Widow, duly and regularly executed a Warranty Deed
dated September 7, 1965, in favor of Robert L. Rayback and Margery M. Rayback, "by the
entireties," which Warranty Deed was filed for record in the office of the County Clerk
within and for Lincoln County, Wyoming, on the 215t day of September, in Book 71 PR on
Page 277, reception no. 390837.
6. That on the 24th day of April, 1990, Robert L. Rayback and Margery M.
Rayback, husband and wife, purchased the following described real property from Roy
Marshall McIntosh and Carol Lynn McIntosh, husband and wife:
The East fifteen (15) feet of the following described tract ofland:
~eginning at the Northwest Comer of Lot #2 of Block #19 in the Town of
Afton, Lincoln County, Wyoming, and running thence South six (6) rods,
thence East 105 feet, thence North six (6) rods, thence West 105 feet to the
place of beginning.
SUBJECT TO all easements, exceptions, restrictions, reservations and rights
of way of sight or record.
7. That Roy Marshall McIntosh and Carol Lynn McIntosh, husband and
wife, duly and regularly executed a Warranty Deed dated April 24, 1990, in favor of Robert
L. Rayback and Margery M. Rayback, husband and wife, as tenants by the entireties,
Grantees, which Warranty Deed was filed for record in the office of the County Clerk
within and for Lincoln County, Wyoming, on the 22nd day of May, 1990, in Book 286 PR,
Page 10, reception no. 717732.
RECEIVED 4/16/2007 at 2:29 PM
RECEIVING # 928433
BOOK: 654 PAGE: 523
1 JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
092~433
000524
8. That at the time of said purchases, and the execution and delivery of the
above-described Warranty Deeds, the conveyances of the real property hereinabove
described were made to Robert 1. Rayback and Margery M, Rayback, husband and wife, as
tenants by the entireties, and they owned and held the title to said real property as such
tenants by the entireties with rights of survivorship continuously from said September 7,
1965 and April 24, 1990, respectively, until the death of Margery M. Rayback on February
11, 2006 at Afton, Lincoln County, Wyoming.
9. That Robert 1. Rayback survived Margery M. Rayback, and by virtue thereof,
said tenancies by the entireties vested in him upon the death of said Margery M. Rayback
and that he then became the owner in fee simple of all the real property held as such tenants
by the entireties hereinbefore particularly described.
10. That this affidavit is made in accordance with the provisions of Section 2-9-
102, Wyoming Statutes, 1977, and that the Certificate of Death hereunto annexed, and by
this reference made a part of this affidavit, is a copy of the official death certificate of the
decedent, Margery M. Rayback, certified to by the public authority in which such original
death certificate is made of record.
DATED this ~ day of March, 2007.
1
Gloria Sem
of the esta
deceased
The State of Wyoming )
:ss.
County of Sweetwater )
SUBSCRIBED AND SWORN to before me this ~:O'a\ day of March, 2007, by
Gloria Sempsis. \\\\"UU/I"I.
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DEPARTMENT OF HEAL 'fA
000526
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0928433
LOCAL FILE NUMBER
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SMTE FILE NUMBER
,. OECEOENl"S LEGALNAME"(InducIeAKA':¡,U ..n/) .;:II~I. MiI 'Jle.lm;U
Margery Mersetta Raybac~
4. SOCIAL SECURITY NUMBER
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\711. PL;iliCE 'òf DEATH "CÇher.k '611{~ Imer
IF DEATH OCCURRED I'" II HOSPITAL: IF DEATH"OCC~RED ~ÖMEVIottERE ()!HER THAN A fi9s~IT"L:' :;:; : _. ,:: :"
o Inpalient . n EA f ~IPflllonl 0 Hœpttf! F,.edit,. :: (] NUIslng Høriu.l Long Term ~~.~ Facility :,::; ,~Dec~"nl'_lio.'Í1!3:
7b. FACIlITV NAME Ilr nollllntiluUOb: give slreel and numbPf) 7c.' CITY"T~, OR LOCATION OF DEATH
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72 W. 4th Ave.
The Dalles, Oregon
11. EVER IN U.S
ARMED FORCES?
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12d. STREET AND NUMBER
72 W4th Ave
13. FATHER'S N....MEIFlr&I, Mlddlt!.lQsl}
Fay Hamil on
15._ INFORMANTS NAME
Robert LeRoy Raybac~
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CAUSE ÒFDEATI'(
24. PART I. Ent~r Ihe ch l ln of evenls - dl5f!Ø5es, in}lIrlt's (lr cOIT~) (; hon!o ...... Ihnl dll'er:Uy causMlhe delth. 00 NOT enlar lenfl'M/livenls siJch A!: I:fIrdl¡¡c
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PART II, EnlfO,f ülhcr 51{11I11U;.,,'n1 r.nn{lilJan:s r.onhil>\.lt,t\l lro oj~,ê\nl,blll nol i1i~~I,h.~'!1 In IhE! ,\!r.\':I.CI'lymll tatl!5~:M~n ifl PIli! t
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28. IF FEMALE AGED 10-54
o Not prrgnanl wkhiu pasl year
n Pregnant.111me 01 de'lh
o NoIpreg(illnl. bul preunof1l.wilhln <42 daY5 oldealh
30. DATE OF INJURY (UoIDayIVrl
35, IF TRAN5PORTATlC)N ACCIDEtH. SPEClf'j
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38",OESCRIBE HOWINJURV aëCURRED. AND IF TAAf~sPOr~r~.l'JON INJI:t.~.,: né'rY¡:"EJ.~J CiF V~~ICLE(~i INVOLVE.D tf)"IOn ( !J'b...'~kU!'. 'r~~inr('."t;~: ¡\l'Ij.I"q'L I!.;~r.1
31.. CERTIFIER (Chec" (t(dy one)
OIf2t.IVSICIAN - T1),llIo Mstnf my, knowlt!UgI:!, dr.atlt OCCt.ure.::! ~tIh(lli!~~d31,~'n~~1 pll!r.e. IInd~'IC'~o-1h( c.1\151J(~)'Ønd mnn!t"'r.I;!.I'IIOO-:::. ::" ";':'" .....
n CORONER - (lrllhe basIS oleJUlmqlPIIoIi. PlIdIUf 1fI\I1I1119u11(111: 101 lilY ~'liInlOn. :~!e:aIN:OOcum:d.~~.lht: lørre, UPI,/":r,KI ~IJ(.C Q':~ due to)tl(! c,'"~:et~1 antl:irmnllf'i);llllud
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298280
This Is a true certification of the document on file in the office of Vital
Rec.ords Services, Cheyenne, Wyoming.
q~~~
..... LucindaMccaffre: /
'. Deputy State Registrar ..
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'- . This copy is not ~"id unless, ~repared~ on p.aper with an, ~n8raY~,~rder:~isp::I.ying tÞ:~ .da~~.. seal.,an~,:~~8na.t~r.e of t:~e.I~~puty State ~egI~trar.
DATE ISSUED:
FEl3
2í
;oD06