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Affidavit of Survivorship
I, Janelle A. Coulter, being of lawful age and duly sworn according to law,
upon my oath, depose and state:
That under the date of September 13, 2005, for valuable consideration, Dina K.
Iden, by quitclaim deed of that date, which deed was duly filed of record in the Office of
the Lincoln County Clerk, on September 22, 2005, in Book 598 of Photostatic Records on
Page 798, conveyed to Dan R. Coulter and Janelle A. Coulter, husband and wife, the
following described property to-wit:
A parcel of land located in the vicinity of Smoot, Lincoln County,
Wyoming, and being a portion of the Sl/2SW1/4 of Section 32, T31N,
Ru8W of the 6th P.M., Wyoming and shown upon that certain Record of
Survey of the property of Everett D. and Leah Beth Peterson, husband and
wife, prepared by Lloyà B. Baker in June, 1974, more particularly
described as follows:
BEGINNING at a point in the southerly line of said Section 32, said point
being North 89°24'E, a distance of 1115.74 feet from a rock found marking
the Southwest corner of said Section and running Noo36W, 33 feet to the
True Point of Beginning; thence N49°41'48"W following approximately
along said creek, a distance of 144.06 feet to a 1 inch iron pipe; thence
leaving said creek and running N61°19'E, 54,54 feet to a 1 inch iron pipe;
thence running N89°24'E, parallel with said southerly line of Section 32, a
distance of 253.23 feet to a 1 inch iron pipe; thence SOo36'E, a distance of
120.00 feet to a 1 inch iron pipe set in a fence line; thence continuing
Soo36'E, 10.00 feet to a point 33.00 feet northerly of said southerly line of
Section 32; thence running South 89°24'W parallel with and 33.00 feet
northerly, measured at right angles, from last said southerly line, a
distance of 192.47 feet to the True Point of Beginning
That by reason of said conveyance aforesaid, the said Dan R. Coulter and Janelle
A. Coulter, husband and wife, became the owners of said real property, and title thereto
vested in them continuously from the date of said conveyance to the date of death of Dan
R. Coulter, on the 21st day of April, 2006. That by reason of and upon the death of Dan
R. Coulter, title to the above described real property vested absolutely in Janelle A.
Coulter.
Affiant avers· and certifies that Dan R. Coulter is the identical party named with
Janelle A. Coulter in the aforementioned deed, whose death terminated his interest, title
and estate in said real property; and Affiant attaches hereto and makes a part of this
affidavit, a copy of the Official Certificate of Death of said decedent, duly certified by the
public authority in which said death certificate is a matter of record.
Dated this L day of Il;#h L ,2007.
RECEIVED 4/23/2007 at 3:13 PM
RECEIVING # 928652
BOOK: 655 PAGE: 346
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ç;A14 if ~?1;der
State of DIJl¡~L0 )
~J:'" A/"A /'" ) ss.
Countyof~ )
Subscribed and sworn to before me, a notary public in and for said County and
State, by Janelle A. Coulter, this \ ~-tj1. day of~, 2007.
WITNESS my hand and official seal.
My Commission Expires: ~' 2h I 2.1JD(
a CAREN R. VANDERFB
CommllllOn # 1~
Î Notary PubIc . CaI1foInIa
1Ukn COW1lV
MyComm. Exf RIAug26.
COUNTY OF TULARE
TULARE, CALIFORNIA
STATE FILE NUMBER
1. NAME OF DECEDENT - fIRST (Ginn)
CERTIFICATE OF DEATH
STATE OF CAlFOANIA
USE BLACK INK ON..Y I NO ERASU\ES, WHlTE0I/T8 OR ALTEAA~S
YS-1I VIA:M
3 2 006 54000843
LOCAL REGiSTRATION NUMBER
15
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Dann
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.~ AKA. ALSO KNOWN AS .- Include lull AKA (FIRST, MIDD...E, LAST)
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II. BIRTH STATEJFOREIQN COUNTRV
10. SOCIAL SECURITY NUMBER
California
Business Owner
20. DECEDENTS RESIDENCe ISI,... IIIId number or 1ocabI
:i i . 3468 East
::) Q 21.ClTY
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a: Tulare
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II: ¡ Janelle Coulter - Wife
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22', COUNTYIPROYINCE
Tulare
East Tulare A
30. LAST (M8.tœn Narn.,
28. NAME OF SUAVIVING SPOUSE
FIRST
211. WDDlE
Janelle
31. NAME OF FATHER FIRST
Perr
33. LAST
32. MIDDLE
34. BIRTH STATE
Cecil
35. NAME OF UQTHER .- FIRST
Jose h
36.IotIDDL£
OK
38. BIRTH STATE
OK
Verla
Naomi
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Cw
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38. DISPOSITION DATE mmldltJcc:yy· 40. PLACE OF FINAl DISPOSITION
04/28/2006 North Tulare
"1. TYPE OF DtSPOSITION(S
43. UCENSE NUMBER
Burial
44. NAME OF FUNERAL ESTABUSHJ.tENT
7909
Goble-Miller Funeral Cha el
FD-423
101. PLACE OF DEATH
102. IF HOSPITAL, SPECIFY ONE
DIP [jJEM:>pDOOA
lOG. FACIUTY ADDRESS OR lOCATION WHERE FOUND (51....(.00 num~ or Ioc:allon
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Tulare District
104. COUNTY
Tulare
St.
Tulare
T1mIIRIINII Bt\wnII 101. DEATH REPORTED TO COAOHEA1
0nIIt1nd0e11l\ [!]VES DNa
tAn 'PJiIVIIÞU._
'Minutes 06-4-487-70
r BY) 109, BtOP8Y PERFORMED?
:y. DVES r¡1NO
, ears ~
I ~ I '0. AUTOPSY PERFOAMED?
! [!]VES DNa
I (DY) IU. USED IN D£TEfIMIHING CAUSE?
¡ [!]VES DNO
. 107. CAUSE OF DEATH
Enlef 1M c::hIIIrr of IIV,,",. -- dI...... Injun.., orcamplk.1\ona - thai dlrødly CA\.IMd dull\. 00 NOT .nfllr lermlnalllV.ms ,ur::h
.. urdIB aneeI, ,,,plmOl)' an... or ......ncuW' flbrin.uon wllhoUl.lho\I.4ng IhItlldogy. DO NOT ABBREVIATE.
IMMEDtATE CAUSE IA)
=I=:V -+
IndNlhJ (81
SequenIlIltv.ISI
j!: condId-.fftllJ.
~ :'~~~E: (c1
o I..NDERlYlNO
t*; CA,USE (dIaN. Dr
~ =~IuIJ. .v.... (O
:l NUtlng In dMlh) LAST
U
Acute M ocardial Infarction
Arteriosclerotic Heart Disease
112. OTHER SJGNlFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING IN THE UNDERL VING CAUSE GIVEN IN 107
None
113. WAS OPERATION PERFORMED FOR ANY CONDITION IN TE~ 107 OR 1121 (II y...1I11 typa 01 opIrIIllan and datt.)
No
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114. I CERTFY TH4T TO THE BeST OF MY KNOWLEDGE ŒATH OCCURRED
AT mE HtU\. DATE. NÐ PI..ACE STATEO FROM THE CAUSES STATED.
a.c.ø.nt A"~ SInce Deøedlnt Lat Bten Altve
mmldlilocyy I IBI mrnlddlcqry
,
,
115, SIGNATURE PM) TITLE OF CERTIFIER
117. DATE mmfddlccyy
~
118. TYPE ATTENDING PHYSICIAN'S NAME, MAilING ADDRESS, ZIP CODE
118. I ŒRnFY TH4T IN MV 0PUfI0N DEATH OCCUAAED ArM IÐUA. DATE, AND PlACE STATBJ FROM THE CAUSES STATED.
r.;] 0 0 0 0....."'" Dc......,..
MANNER OF DEATH tXJNaluraI ~ Homlclda Sulci. If1Io'tsllpllon delermlned
123. PLACE OF INJURY (..g.. home, ctInIlrudIon..... WCICJIt.d' 8!",t. etc.)
120. INJURED AT WORK?
o YES Ii] NO 0 UNK