HomeMy WebLinkAbout928937
000440
STATE OF WYOMING )
)ss.
COUNTY OF UINTA )
AFFIDA VIT OF SURVIVORSHIP
RECEIVED 5/2/2007 at 10:16 AM
RECEIVING # 928937
BOOK: 656 PAGE: 440
JEANNE WAGNER
LINCOLN COUNTY CLERK. KEMMERER, WY
SHELLY FRALEY, being first duly sworn on oath deposes and say:
1. That SHELL Y FRALEY is of adult age and is the surviving wife of KENNETH
FRALEY, who died November 11, 2007, in Elephant Butte, New Mexico, as hereinafter more fully
appears.
2. That by a Quitclaim Deed dated August 23, 2005, and recorded September 19, 2005,
in the office of the Lincoln County Clerk in and for the County of Lincoln, State of Wyoming, in
Book 598R, Page 227, Kenneth Fraley and J an Case, Joint Tenants conveyed to Kenneth Fraley
and Shelly Fraley, husband and wife, with Right of Survivorship and not as Tenants in Common,
of PO Box 1703, Afton, Wyoming 83110, Lincoln County, State of Wyoming, the following
described real estate situated in Lincoln County, State of Wyoming, to-wit:
Lot 10 of the Schwab Addition to the Town of Afton, Lincoln County, Wyoming.
Hereby releasing and waiving all rights under and by virtue ofthe homestead exemption laws
ofthe State of Wyoming.
3. That Kenneth Fraley died on the 11 th day ofNovember,2007, in Sierra County, State
of New Mexico, and thereupon, the certificate of his death was duly filed with the State of New
Mexico and made a matter of record in said office, and a certified copy of said certificate is attached
hereto and made a part of this affidavit.
4. That upon the death of Kenneth Fraley, as aforesaid, the joint tenancy created by the
aforesaid deeds were tenninated, and Shelly Fraley, surviving wife, became vested with all of his
right, title and estate in the above property.
DATED this 1st day of May, 2007.
s~~
SUBSCRIBED AND SWORN to before me by Shelly Fraley this 1 st day of May, 2007.
County of
Lincoln
State of
Wyoming
BECKY BARBER - NOTARY PUBLIC
My Commission Expires August 31, 2010
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Decedent: FRALEY. KENNETH W
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Dete of Deoth: Nov 1 ~.,·,:.?006
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OMI No: 2006:';05339' .....
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Elephant ButteSi!lrra
City of Deoth .CÖtlniýöfÖ!!eth
1b. IF N'ÃT IS FEMALE· Give m.ld.n n.rne. (~I n~\:~:'Pr.;::qO-f~!,~t~i.~:~~J
4c. INFANT· tf under 1 d. e~:::.c:;fI"( Qr"'RTtI. ".: c.
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9. DE ENrS EDl..ICAllON· Q'leeh the -bö.:Ih.U'¡¡~ delClibe. Ih, hlahest
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No. nol Spainlan,lHI,pa¡nlC/lIIlIno AmerlClln lnellen or AI..~.:Ne't-t- _.,.:. .
Yea. Splnilh/HlSpanlo Specify name of the Trll:iiija).::::,' .-:::: ,:.'
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V.., Othe, Hllpanlc OrI,ln (Specify):
If ottw (Speclfy : 0 GUlmenlln or O\8mol'l'o
12b. KIND Of BUSINfSS OR INDUSTRV 0 Olh... PIIctflc l:II."cte, Specify):
Mining 0 Oth..(S..d"~
14. SURVfVING SPOUSE ·If wlf., Ii" melden neme (nam. Pllor to n,.t maffia..,
Shelly R. Lambert
16. MOTHER'S fUlL MAIDEN NAME· Give name prlo, 10 first m.rrla..
Catherine E. Fraley
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30. MANNER OF DEATH 0
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COMPLETE INJURY SEenOH FOR ACCIDENT.
HOMICID:E.':SWC~~;OR ~DETERMINEO
321. DA 0 NJURY
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32.. iNJURY AT WORK
OVeslllNo
33. CAUSE OF DEATH
(Type Of print ct'lrly)
32c. OF INJURY . (Sped decedent I hom., Itreet, Inte""lle,
erroro. reltau,ant, etc.) Residence
32d. LOCAnONOFINJURY·(Addr.u, ty¡;Stlt....ZlpCoci.t,. ":
Elephant Butte Sierr.a i1ÎM81~35
c. It. v:~:'pec;.1
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PART I. Enllf lilt ohlin of evenll- ........ !+riM. orcompllelllona. ....1hcIrcalUd III .,IIL 00 NOT Iftter _1n1l.....nbI tueh II_clIO _tit, rllfl"'aIory
...It IhIh. CII' Ylftrrioul. fibril. wRhouI iltlcMmgltt lMoIogy. DO NOT en. "OW A.". 00 HOT IbbmtIIIt. En!.- only.... CIIUIt DIll h. Add eddiØonllh.
r neoelury
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Olhe S ~
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Onset 10 ..
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IMMEDiATE CAUSE IFinal dlse... 0'
condlllon ,..unlnl!ln.deelh) ...
Gunshot wound of head
Du. to IOf ... con..quenoe of):
See nd
Sequentlllly IIsI conditions, If any, I..dlnl
to 1he ctuse listed on Hn. a. Ent., th.
UNDERl.YING CAUSE fdlu... Of" InJurv
Ih.'lnltlal.d the eventa ,.Iultlnlln death)
lAST.
b.
Due to (0' II . consequ.nc. of):
..
III V.. N.
R I
0 V"
36b. IF YES, wer. nndln.. conald.,ed In delermlmRl cause 0' death?
N.
37b. IF YES, Specify Type of Procedu,.
3 I H 0 0 .',::.. 0
DEATH? 0 Y.a 0 Problbly .' '.-. DÈÁTHi::,.": ':0 Ve. 0
o No III Unknown 'œ No 0
31S0. LOCATION WHERE: AUTOPSV WAS PeRfORMED ICltr. Stater;:'
A1buquer ue, NeWi~!I.1f;ieo
370. ~T~,:þF·PR~.~t1~~nUtlOa)'/V..,)
o
Problb'r
lInknow.
Du. 10 (or II . con"qu.ncI of):
:':·.·:;·:·.:ï.:
Due to fOl' II . con$lquence of):
PART II. Enle, olh., Illnlflelnt condIUon..:.~nlrl~~.i~~." .t,~ death bul not rllSultlnlln ¡he underlyln, CIUI'l!vlln In PART I.
Ian Paul, MD
i9~,()~
State Registrar"
o Not Pre,nent. but p'lIlnanl 43 days 10 1 y.., berore dealh
o Unknown if pre,nlnt within 1 ,..r of death
....Q ·:.:::-m~:~l:~~1horltr
.. . t;j:-: .··.--Mlllt.,y.'AUthorllr
..0 Other (S~~lfy):
CERTIFIER STATEMENT: On the b",il 0' .xamir'iâìiö~.¡;: öt ¡¡West! atlo
40c. SIGNATURE OF CERTIFIER
Signetu,e Electronlcelly Aut/:1.~';íl¢å¡~(f::: ',',...
40a. NAME OF CERTIFIER (PIIII" trp. or print clearly):
nlon, Ihls death occuffed lithe lime. date and lice, Ind due10 thll cause I and mlnner ,tlted.
40d. DATE SIGNED IMontn,lOlrtyear'
NOv 15, 2006
CERTIFIED COPY OF VITAL RECORD ....:...:....
This is a true and exact reproduction of all or part of the docuiÎiéijt:i
officially registered and filed with the New Mexico Vital
Records and Health Statistics, Public Health Division,
Department of Health.
DATE ISSLmOV
2
?006