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000101.
AFFIDAVIT OF SURVIVORSHIP
RECEIVED 5/16/2007 at 12:00 PM
RECEIVING # 929387
BOOK: 658 PAGE: 101
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF AlASKA )
¡::\e.~'t'" ~ 'þ \C..\ ~ \... )SS.
.counTYOF ~\~"1"~\C\ )
I, Dawn M. Findley-Groves, oflawful age and being first duly sworn, on oath, deposes and states:
1. That she, Dawn M. Findley-Groves and her husband Thomas W. Findley were owners by tenancy
by the entirety in the following described real property:
LOT 25 OF STAR VALLEY RANCH PLAT 16, UNCOLN COUNTY, WYOMING AS DESCRIBED ON
THE OFFICIAL PLAT THEREOF.
as is evidenced by that certain Warranty Deed dated August 11, 1997, wherein Dan M. Thompson and
Marilyn J. Thompson, husband and wife, were named as Grantors, and Thomas W. Findley and
Dawn M, Findley-Groves, husband and wife, were named as Grantees, which Deed was duly
recorded with the Lincoln County Clerk on August 15, 1997 in Book 4ooPR, Page 512.
2. That Thomas W. Findley is deceased. A copy of his death certificate is attached hereto as Exhibit
"A" and incorporated herein by this reference.
3· This affidavit is made pursuant to Wyoming Statutes 2-9-102 to evidence the termination of the
interest and ownership of Thomas W. Findley, in the property described above; and the sole
ownership of Dawn M. Findley-Groves as the surviving tenant,
Dated this ~ day of r<\ø..y , 2007.
~::ro. ~ :"NQ~~- f\~
Dawn M. Findley-Groves
STATE OF AlASKA )
ç-,~,"\ ~ I.A. b. ,(..\ ~L. ) SS.
oomITY OF ~ \. ~\1lL1 C\ ) .
Subscribed in my presence and sworn to before me by Dawn M. Findley-Groves this ~ day of
~,2007. .
Witness my hand and official seal.
",,' ;~"""""""Óf'!'t"~_!~'i~~;'" ",^"
..,.........:.. 0),'
¡STATE OF ALASKA
OFFICIAL SEAL
Michele Bossio
NOTARY PUBLIC
I\Ay Commission Expir¿.s.
My Commission expires: .2.f.j g / .:Jvo g'
11. Decedent's Race(s)
White
. Decedent's Education
Doctorate or Pro Degree
12. Was Decedenlever In U.S.
Armed Forces? Yes
Juneau
13g. Inside City Limits?
D~s DNo DUnk
13b. City or Town
13d. Tribal Reservation Name (Wapplicabla) 13e. State or Foreign Country
AK
16. Surviving Spouse's Name (Giva name prior to first marriage)
Dawn Mason
(00 NOT USE RETIRED). 18. Kind of Business/Industry (Do not use Company Name)
Law
.~-:
"t:.,
"~' 4. Place or Death. ¡r Death Occurred in a Hospnal;
In Patient
5. Facility Name <II not a raclllly, glva numbsr & streal or location)
2. Relationship to Decedent
Wife
O. Mother's Name Before First Marriage (First. Middla. Last)
Catherine Frances Davis
3. Mailing Address: Number end S...'...RFO No. C'yorTown StaI.
1409 Mary Ellen Way, Juneau, AK 99801
: Place of Death, if Death Occurred Somewhere Other than a Hospital:
,
,
Zip
6a. City. Town, or Location or Death
Seattle
7. Zip Code
98101
Cause of Death (S.8 Instructions and examples)
4. Enter the chain of events - diseases. Injuries, or complications - that directly caused the death. DO NOT enter terminal events such as cardiac arrest, respiratory arrest, or
entrlcular fibrillation without showing the etiology. DO NOT ABBREVIATE. Add additional lines ir necessary.
a.
:1
equentially list conditions. if any, leading b.
o the cause listed on line a. Enter the
NDERL VING CAUSE (disease or injury
hat initiated the events resulting in
eath)LAST
c.
Due to (or as a consequence of):
:Interval between Onset & Death
,
,
d.
5. Other sianlficant conditions contributina to death but not resulting In the underlying cause given above
'~I
~
~ 18.)IIanner of Death
.ß' M Natural 0 Homicide
-g; 0 Accident 0 Undetermined
I']i' 0 Suicide 0 Pendin
f'~ 1. Date of Injury (MMIODIYYVY)
IN
I~
111.
I
!
9. If female
o Not pregnant within past year
o Pregnant at time of death
7. Were autopsy findings available to
mplete the Cause of Death?
o Yes 0 No
2. Hour of Injury (24hrs)
o Not pregnant, but pregnant within 42 days before death
o Not pregnant. but pregnant 43 days to 1 year before death'
o Unknown if re nant within the ast ear
3, Place of Injury (e.g" Decadent's home, conslrucllon site, restaurant, wooded sres)
O. Did tobacco use contribute
to death?
o '!JIs 0 Probably
~o 0 Unknown
4. Injury at Work?
o Yes 0 No 0 Unk
Api No.
Count:
Stste,
ZI Code. 4:
7. If transportation injury. specify:
o Driver/Operator 0 Pedestrian
o Passenger 0 Other (Specify)
I!
8b. Medical Examiner/Coroner. On the basis of (JxamÎrtatiün, and/or jn\'~~stiga1¡oli. ÎlI my
op,nion. death o<:;curmd at the time. date, :.:m(1 pta.:e, and clue to the ~ause.ls) and mann&t 3latG<:I