HomeMy WebLinkAbout934576
¿VI '\
COUNTY OF LINCOLN
RECEIVED 11/2/2007 at 2:12 PM
RECEIVING # 934576
BOOK: 677 PAGE: 567
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT TERMINATING ESTATE
000567
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SS.
6010715825
STATE OF WYOMING
I, Florence Parker fka Florence H. Madsen, being of lawful age and first duly
sworn according to law, upon my oath, depose and state:
1. That I am of adult age, a resident of Etna, Wyoming, and the Affiant
herein.
2. That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 90 PR on page 128 is recorded a Warranty
Deed. The Warranty Deed , dated the 23 day of
August, 1970, I conveys unto Dennis V. Madsen and Florence H. Madson
Husband ~nd Wife, with full rights of survivorship the following
described property, to-wit:
3. That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 110 PR on page 299 is recorded a Warranty
Deed. The Warranty Deed , dated the 14 day of
Febr_uary 1974 conveys unto Dennis V. Madsen and Florence Madson
Joint Tenaqts, with full rights of survivorship the following
described property, to-wit:
See attached Exhibit s flAil, "B", "efl
4. That said Dennis V. Madsen died on the 6th day of
July , 1977 , and a copy of the original certificate of
death~ certified to as true an correct by public authority in which the
original of said certificate is a matter of record, is attached hereto as
Exhibit "A".
5. That by reason of death of said Dennis V. Madsen and by reason
of 2-9-102W.S. (1980), the decedents interest and title in said conveyance
has terminated and title to the real property conveyed thereby has vested
absolutely in Florence H. Madsen continuously since the death of the said
decedent.
FURTHER AFFIANT SA YETH NOT.
Dated_I}) - ;)S, OJ ~ .büR-~~
Florence Parker fka Florence H. Madsen
State of Wyoming )
)ss.
County of Lincoln )
The foregoing instrument was subscribed and sworn to me by Florence
Parker fka Florence H. Madsen this [;(5 day of October, 2007
Witness my hand and official seal.
My Commission Expires:
~k~
Notary Public
/O-QS-07
County of
L.lncoln
NOTARY PUBLIC
State of
Wyoming
Mv Commission Expires September 15, 2011
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:1' 128 Exhibit A RECORDED-AQr. 2::3. ~q70 ~lq:OO :J\iI
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, NO. 'j (iIi:i',..;¡¡;;,:!;!:çr-MA4 n·vTl..!1. COUNTl CLf~¡;
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gJ'all.tor_ß.._, o:l ___.:._______CJ.arL____~--.:.-------------..----------.,----------..._________________COulI.ty. aDd State
of_____~J!.~A___________..:::_________, for and III. co~ideratlon _oÍ-_____________'_____________________________________.
TEN AND HO/10oths-------_________________________________________-----------DO..ARS
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in hand paid, receipt whereo:l Js hereby acknowledged, CONVEY AND W ARRANT TO___________________~--------------
~_..P_WNI S_ V. MAp.1L:ç;~LMID _f.kOR~~Ç,Æ._!!.:__~_~~.!L__h!:1_~Þ..~1!9__~~_(L~!~_~_____________________
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grantee____, of -------_____..cJArk..~________________County end State 01________Ne.vada.._____________________
the following described teal estate, sItuate In------------_____J.¡¡~QUL----------------------------County aDd State
of W)'omJng, hereb)' releasing and waiving all righta \1nder and by' virtue 01 tbe bomeatcad exemption lawI of tbe State,
to-wlt:
Lots 70 to 72 1nc~usive of PRATER CAm'ON ESTM!ES UN.I~ 1'/0. TWO,
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INDEXED 0
¡,aSTRAC'fm
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WITNESS____JII¥________ hand________ thls_-3la.t____day of_________....Iem1~-------. 1II,.7,(L.
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____.:.___~,. _-3__~~ ,gsr.t'U
WILLIAM C. CASSELL
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_,State nf NEVADA
County of ~T;ARK' '
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day of:
'·.19~.
TheforeglJlng instl·ument was acknowledged before me this
Witness my hand and offidalsea1.' .
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. Sigoature.
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'8 .....................,,!t..................~..f'I.. .
:: Notary Pu bIle· State o! N wed 3
:: CLARK COUNTY
! MARIAN: J.' SHAY" '¡",
¡ . My Co~~I8IIDII Explras May 7. 1973 r. .
, '~..a~J!~~a..a...,__.
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',Title of
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My Commission ExpIres:
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000568
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10/25/20~-
. ': 59
13078773101
LINCOLN COUNTY CLERK
01/01
"'-cKm"'l"I4tNI INK
SEE HAN~JOOK FOR
INSTRUCTIONS
DECEASED -NAME
-_.,....
- - -.... .",:'of'
ST"" flU NUMln
flUT
1.
Madsen
2, Male
], July 6, 1977
COUNTY OF DEATH
MIDDLE
tA$r
SEX
DATE OF DEATH 1 MONTH, OAT, YEAI'
4,
CITY. TOWN, OR LOCATION Of DEATH
RACE WHITE, NEGIIIO, AMERICAN INDIAN,.
IETC. r 5P'ECt,y I
1ifhi te
.,' .
7b, Afton 1(, ves Id, Star Vallev Hospital
STATE OF BIRTH' If Nor IN U.S.A.. NAME CITIZEN OF WHAT COUNTRY MARRIED. NEVER MARRIED, SURVIVING SPOUSE C IF WIFE. GIV' MAIO,N NAM' J
I h COUNTI" U S WIQP.WED..p¡VORc,EO ImCIFY' Fl Humph e rTJ'_ s
I, da 0 9,. .A., lol'iar.c.'lea 11, orence _y
SOCIAL SECURITY NUMBER USUAL OCCUPATION IGIVE KINO OF WOIK OONE DURING MO., Of KIND OF BUSINESS OR INOUSTRY
WOAAING un:, EVEN If REfiRED J
USUAL RESIDENCE
'HHUE DECEASED
LlVEO.
L~
12, t;18-t;O-7098
RESIDENCE-STATE
lJa,
Laborer
FIRST
MIDDLE
Oil Company
INSIOE CITY LIMITS STREET AND NUMBER
(S"fCJfY YES 011 NO J
ves
)3b,
COUNTY
CITY, TOWN, OR LOCATION
14<. Thayne
...,~~~~~
140, t'¡vomin~
FATHER-NAME
mLinc.oln
lAST
Hd,
MOTHER-MAIDEN NAME
14"
15,
I NfORMANT -NAME
, Vance
Dunford Madsen
flII5T
MIDDlI
LAST
Jovce Haddock
:/
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ITa,
PART I,
18,
Florence Madsen
I STRUT 011 lI.f.D. NO., CITY 011 TOWN, STA", ZIP J
IMMEDIATE CAU$£
lIb,
[ENIER ONt Y ONE CAUSE PER LINE FOR (0). (b), AND (en
Thayne
lrlvominl:!
8~127
DEATH WAS CAUSED BY,
R AS A CONSEQUENCE Of:
S'e ve (e.
ß
A.... OXIMATE INfUVAL
I!TWUN ONsn AND DIEAfH
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(al
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/Jß(oJ ; c/Q I'l -¡-
PART II. OTHER SIGNIFICANT CONDITIONS, CONomONS CONTt"UIING TO DEATH BUT NOT OHAT.O TO CAUSE GIYEN IN 'AU I 101
CONDITIONS, If ANY,. ¡
WHICH GAVE IIISE TO
IMMEDIAfE CAUSE 101,
UATINO fHE UNDU.
"'"~:"'? ï'V
(e)
{b
IF YES W... fiNDINGS CON-
SIDERED IN DnUMIHINO CAUSE
O'DIATH
I9b,
( ENTER H"'ruu OF INJUII:Y IN .....IIT I 011 ,...IIT II, IrEM ...
THIS IS TO CERTIFY that this reproduction is a true copy of a record on file in
Vital Records Services, Division of Health and Medical Services, Wyoming Department
of Health and Social Services, Cheyenne, Wyoming.
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Date Issued
August 15.
1977
Lawrence J. Cohen, M. D.
S{;liSt?h t
B k)
~State Registr '
Vital Records Services
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If this copy does not bear a raised seal and the signature of the Deputy State
Registrar is not in red, this is not an official certified copy.
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THIS'l;;i~ic1&~"1~\~E~~i~ reproduction is a true copy of a record on file in
Vita11Rec\rds~i~~~, 'Division of Health and Medical Services, Wyoming Department
of~~a'l~h,~. söç;,.¡tl; SÚ'Vices , Cheyenne, Wyoming.
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Lawrence J. Cohen, M. D.
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y -- - state4t¿ist a"
Vital Records Services
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Date Issued
August 15. 1977
If this copy does not bear a raised seal and the signature of the Deputy State
Registrar is not in red, this is not an official certified copy.
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