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674158
AFFIDA VIT
REGE I\lED
..lNCOLN COUNTY OLERI<
01 JIHr! 27 P['l It: 17
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I<EMMEHER. \VYOMiNG
STATE OF WYOMING
SS
BOOK 46~? PR PAGE 37' 5:
COUNTY OF LINCOLN
I, EIRay Titensor, being first duly sworn on oath, depose and say:
That I am a citizen of the UnitalStates of America and over the age of 21 years, and a
resident of Afton, Wyoming.
That I was well and personally acquainted with Roscoe Titensor and Elnor Titensor as
described in that certain Warranty Deed dated June 1, 1978 and recorded July 10, 1978 in Book
147PR on page 400 of the records of the Lincoln County Clerk.
That I know of my own knowledge that Roscoe Titensor and Elnor Titensor in the above
described Warranty Deed and mentioned in the attached Certified copies of Certificates of Death
were one and the same persons.
This affidavit is intended to terminate the life estate of said Roscoe Titensor and Elnor
Titensor in the following described property:
The Westerly Ih of Lot 3 of Block 15 of Bedford Townsite, Lincoln County,
Wyoming as described on the official plat thereof.
LESS AND EXCEPT the land contained in Warranty Deed recorded January 13, 1977
in Book 133PR on page 80 of the records of the Lincoln County Clerk.
Dated this 2. S- day of June, 2001.
4;
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J-J?;;:-~
EIRay Titensor
State of Wyoming
County of Lincoln
The foregoing instrument was acknowledged before me by EIRay Titensor thisa.?~
day of June, 2001.
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My Commission Expires:
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DEPARTMENT OF HEALTH
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STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
376"
TITENSOR
2_ SEX:, '.
ema~e
ST...-n:! FLE Nu..8EA
l, ""11; OF IlEAl" ,1110.; ,~. ltJ
~arch 4; 2009
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April 7, 1909
" BUSINESS OIlINOUSTfIY
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. DUIS lO"(CMl AS It CONse~ueNCE OFJ~
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122086
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This'is a true 'and exaci"'apro'duction of the document on file in the office of Vital
Recolds Servioes, che~enne'/CfARh9'1 4 2000
DATE ISSUED: ' .
q~ /#Y1f7
'Lucinda Mccaffrty/.
Deputy State Registrar
This copy Is I'lOlllalid unles~ "prep~,red p~ paper wl~h an engraved border displaYing the datel seal and signalure of the Deputy Slate Reglslrar.
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TypE
OR PRINT
IN
PERMANENT
INK
FOR
INSTRUCTIONS
SEE
HANDBOOK
O~3~;41.S8
LOCAL FILE NuMBER /
DECEDENT-NAME FIRST
STATE OF WYOMING
377
DIYISION Of HEALTH AND MEDICAL SER\l1CES
CERTIFICATE OF DEATH
m
STATI;: FILE NUMBER
DAAugE:T2rS~Dav-r9 8 6
J,
DATE Of BIRTH (10111.. Va.\', ~'r_)
MIDDLE
. fi\ LAST
.,11 tensor
SEX
UNDER' YEAR
2,
UNDER 1 DAY
MIN$.
alVIay 17. 1986
1.
7C.
COUNTY OF DEAT.!;'
LlnCO.Ln
7d,
WAS DE~NT EVER IN u.s.
ARMED ,
(SpcdJ.'v )
12,
IF'DEATH
OCCURRED IN
INSTITUTION.
SEE HANDBOOK
REI3ARDING
COMPlETION OF
RESIDEN~
8.
SOCIAL SECURITY NUMBER
U.S.A.
9,
MARRIED, NfVE~ MARRIED, SURVIVING SPOUSE /l!wi(c,gilJr lil(liflt:1I flame)
WID1ffarfRr~(If<;ry) EInor Bishop
10. 11.
USUAL OCCUPAfION. (Givt Itil'ld of work dan~ during mol' of
Teach e ~"k.llIg lil~. C~~11 ifrel;,.~d)
14b.Education
STREET AND NUMBER
125
INSIDE CITY LlMI'fS
(Sprc'N'OllrN(lJ
156.
FIRST
MIDDlE
15c.
LAST
Bedford
KIND OF BUSINESS OR INDUSTRY
13,520-14-2224
RESIDENCE-STATE COUNTY
15~incoln
14.,
CITY. TOWN OR LOCATION
Thomas Edward
Titensor
MIDDlt=:
Goaslind
LAST
INFO~MANi -NAME: rT,vpf! Of' PrintJ
MAILING ADDRESS
18b. Box 125 Bedford
CEMETERY OR CREMATORY-NAME
Cemetery
CITY OR TOWN
WY 8)112
STATI;
ZIP
18a. EInor Ti tensor
lOCATION CITY OR TOWN Sl'A.TE
Bedford Cemetery
Schwab Mortuary
19d,
NUMBER ADDRESS OF FACILITY
45 Afton. \ruY
2D1i.
8)110
228_ On 1M basis of 8)j;amine:tion a.nd/or invBBtigaticn, In my opiniol"l dEloth O(;curr~ at Ihe time,
date and pll'lce and Que 10 1n. cal,l.!j.I;t(.s.) S1a~9d.
(Signaiurl!: Q"d Titlel ..
DATE SIGNED/Ma" Day. Y/,,) HOUR OF DEATH
A.
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So
Jla;
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22b.
PAONOUNCEDD~ADIMD ,Do.v. YrJ
22c.
PRONOuNCED DEAD, HfJ1Jt")
M
21d,
NAME AND ADDRESS O~ CERTIFIER (PHYSICIAN OA COAONEA) fT.ypf: 01" Prinu
22d, ON
22e, AT
M
2J.
7~"../J"Y'Y')
REGISTRAR
CON 011' IONS
IF ANY
WHICH GAVE
RISE TO
IMMEDIATE
CAUSE
STAriNG rHE
UNDE RL YINCi
CAUSE LAsr
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24a. (.';iJ,tIIQ.l!lI'i'.J
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IMMEDIATE CAUSE , Ii
(aJ C. V '
OUE TO, OR AS A CONSEOUENCE OF:
~--"-"-,----L1-9 e.-
DU" TO. OR AS A CONSEOUENCE or,
I lnlal'w'al between onset and death
: 5dA.
I'n'o"al ,,"Iwoen ot:!:.nd dealn
I
I ,
,Inlo/val between bn&Bl and dealh
I
25.
PART
I
Ace., SUICIOE. HOM., UNDET., DATE Of IN.JL!RY (MD., [)a...., Yr.) noun OF INJURY
;:.~.NDING INV.ST, (SI"~'r;~~~; iii:;"':";"", 280,
INJuAY AT WOAK (SJlj:d/_~ 'Y/!~(. L~ ,I; 0 IQVUAY-A1 home, I~rm. st(Q61, faclory. cUlce building,
- /lr-Mil ) \" \ - 01:. 'J _etr;.(SpI!dfy)
286, ,;:'.::: D2:\< .: 2;......,;..0:;,.
26,
DESC/lIBE 110 IV INJU/ll' OCCU/lRED
AUTOPSY (Spec4'y Y€ii
orNoJ
No
I<J
PART
II
OTHER SIGNIFICANT CONOIT1QNS-Candllions contributing 10 death but no. related 10 C8US" given in Po\A.T I (a)
M 2ed.
lOCATION
STREET OR,R,F,D, No,
crrv OR TOWN
STATE
28g.
, , ",'", -- 'j
Date I ssued ;::<.&eI?1;.~mper 4'.:<:::::-.1986
7~,;.~,: (~.:: }-/ -i\. :'~
THIS IS TO cf,Rr.:j:l:y'''t-H-a't(thls' :G~production is a true copy of a
Vital Records"j~r\dces, Divisfon of Health and l1edical
of Health andS'?~'~~Jj{:~.~.~Y!'~es, Cheyenne, Wyoming.
If this copy does rid~'bear a raised seal and the signature
Registrar is not in RED, this is not an offiCial,5jtified
~/) "/ (- I
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Lawrence J. Cohen, M. D. '- RichardO. Hall
State Registrar Deputy State Registrar
record on file in
Services, Wyoming Department
of the Deputy State
copy.
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