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AFFIDAVIT TERMINATING JOINT TENANCY
STATE OF WYOMING )
)SS
COUNTY OF LINCOLN )
I, LOLA FRANCES ROTH, being of lawful age and duly sworn according to
law, upon oath depose and say:
1. That Edward James Roth was my spouse;
2. That by certain Warranty Deed, dated September 30, 1991, and filed with the
Lincoln County Clerk on October 1; 1991, as recorded in the Public Records of Lincoln
County, State of Wyoming, Book 302PR, Page 99, conveyed real property to Edward
James Roth and Lola Frances Roth, as Tenants by the Entrireties, the following described
real property, to-wit:
Commencing at the Southeast Comer of the SW1f4NE1f4 of Section 31, T31N,
R118W, 6th P. M., Wyoming, and running thence North 11 rods; thence West 20
rods; thence South 11 rods; thence East 20 rods to the place of beginning.
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EXCEPTING THEREFORM the following described tract of land: Beginning at a
point which is 245 feet West from the Southeast comer of the SW1f4NE1f4 of
Section 31; T31N, R118W, 6th P. M., Wyoming, and running thence North 179
feet; thence West 85 feet; thence South 179 feet; thence East 85 feet, to the point
of beginning.
SUBJECT TO all easements, exceptions, restrictions, reservations and rights-of-
way of sight or record.
3. That by reason of the above-said conveyance, the said Edward James Roth and
Lola Frances Roth became the owners of the said described real property as Tenants in
the Entireties; and title thereto vested in them continuously from that date of the
conveyance as described in the above deed to the date of death of the said Edward James
Roth, which occurred on December 6, 1996;
4. That by reason of and on the date of death of the said Edward James Roth,
Lola Frances Roth became the sole owner of said real property; and
5. A copy of the official Certificate of Death of the said decedent having been
certified by a public authority is hereby attached and made a part hereof as Exhibit "A".
AF~TSMTHNOTFURTHER
DATEDtJús /'/¡tL day of 4'-4
,2007.
RECEIVED 7/19/2007 at 12:45 PM
RECEIVING # 931419
BOOK: 666 PAGE: 314
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
t~~
';J6-Þo.... 1:.. 'I{ CJ :f~
LOLA FRANCES ROTH
AFFIDA VIT TERMINATING JOINT TENANCY
Roth/Roth
Page 1 of2
....î0315
SUBSCRIBED AND SWORN TO /~me, a No
State and County above-mentioned, on this liúlay of
personally by Lola Frances Roth.
Public in and for the
2007,
WITNESS my hand and official seal. ~ .£.. '
hJ )/Z~~ Y(µ?U¿J
OTARY PUBLIC _/
My Commission Expires: ~/c:;{ ~l
AFFIDA VIT TERMINATING JOINT TENANCY
RotlllRoth
Page 2 of2
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STATE OF WYOMING
DEPARTMENT OF HEALTH
#,JI~
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
aWE FIlE NUMBER
3. II-'TE OF I...... ItJ
T"tI'E
OR PAHT
N
Æ/IMAIEHT
lUCK
N<
FOR
INSTRUCTIONS
SEE
HANDBOOK
lOCAL FI.E NUMBER
1. DECEDENT·NAME F1AST
I. SEX
-.e
lABT
EDWARD
JAMES
ROTH
MALE
DECEMBER 6, 1996
e. II-'TE OF BIRTH (..... Oor. ItJ
JANUARY 16, 1921
.. 8OCW. IECUIITY MIMIIER
338-14-6809
1
-
7a. PlACE OF DEA11i (ChtIcIr only one)
!II12IW.:Xb-4>oIIont OER/OU....1ont ODOA IIIIW!: 0__ O~ O""""/~I
TO. FACIUTY NAME I. ... _ ... _ .., _I 10. CITY, toWN, OR I.OCIITION OF DEATH
STAR VALLEY HOSPITAL AFTON
let. COUNTY OF DEATH
LINCOLN
.. 81>\TE OF BIRTH I. ... .. IL&A., .... _I
ILLINOIS
11. M8 DECEDENT EVER IN U.8. ARMED FORCES'
1~ OIorllOl
120. KINO OF BUIlNE88 OR INDUIßAY
13L Æ8IOENCE . &WE
ROAD 151
MECHANIC
AIRCRAFT & AUTOMOBILE
130. CITY, 10WN OR LOCATION
WYOMING
130. INSIDE CITY LIMITS'
1~ OIorllOl
NO
SHOOT
... ~ DECEDENt OF HIIlAlNC ORIGN'
1_1IjI no or VOl . . ..., ....."
Cuban, MexiDM. PuIrIo mc.n. Etc.) ,
17. FATHER'IMAME
NoX)( Yo. 0 (~I
-
EDWARD
PUS CAR
....
- ...-
JOHN
'I.. eNFORMItNT -NAME (J)pe Of AWl
lib. REIAT10NSHIP TO DECEDENT
LOLA
LOONEY ROTH
WIFE
100. MAIUNO ADORE88
P. O. BOX
STREET OR flF.D. MJMBER
Zll'COOE
83126
WYOMING
8WE
AFTON
130. ttOlM OF DEAtH
M
_:Ie. PAONOUNCED DeAD (Hotrl
NOEL STIBOR MD.
AFTON, WYOMING 83110
2'" II-'TE AECEM!D BY REOIIITIWI (..... ..... ItJ
/:z._?-F'£
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21. _R OF DEATH
300. DATE OF INJURV
(- Dor. _I
3Ob. TIME OF
INJURY
3Oc. INJURY AT _,
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14919
This Is a true and exact reproduction of the document on lIIe In the office o( Vital
Records Services, Cheyenne, Wyoming.
c/~#1f7
Lucinda McCaffrey
Deputy Stata Registrar
This copy IS not vaUd unless prepared on paper wtlh an engraved border displayIng Ihe date, seal and signature of the Depuly State Registrar.
DATE ISSUED:
DEC
I 2 /996
EXHIBIT "A"
M