HomeMy WebLinkAbout935185
RECEIVED 11/28/2007 at 10:36 AM
RECEIVING # 935185
BOOK: 679 PAGE: 757
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
THE STATE OF WYOMING
)
) ss.
)
O()0757
COUNTY OF UINTA
J. REED BROWN being first duly sworn upon his oath, deposes
and states as follows:
1. On the 12th day of May, 2003, my wife, JOYCE R. BROWN,
a/k/a JOYCE BROWN, a/k/a JOICE BROWN, passed away, as is evidenced
by the official certificate of death attached hereto and
incorporated herein by this reference.
2. At the time of her death my wife jointly owned certain
real property with me, said real property being located in the
( County of Lincoln, State of Wyoming, and more particularly
described as follows:
~
Beginning at a point Ten (10) rods North of the Southeast
corner of Lot Four (4) in Block Fourteen (14) of the
Afton Townsite and running thence West Eight (8) rods;
thence North Seven (7) rods, Four (4) feet, One and One-
half inches (1~"); thence East Eight (8) rods; thence
South Seven (7) rods, Four (4) feet, One and One-half
inches (1~") to the place of beginning.
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Said real property was originally conveyed to J. REED BROWN and
JOYCE R. BROWN, husband and wife, by Warranty Deed dated May 28,
1970, and recorded in the Office of the Lincoln County Clerk and
Ex-Officio Register of Deeds on September 30, 1970, in Book 91PR at
Page 453.
000758
3. At the time of her death my wife jointly owned certain
other real property with me, said real property being located in
the County of Lincoln, State of Wyoming, and more particularly
described as follows:
SE~NW~, E~SW~, SW~SW~ and SW~NW~, Section 34, Township
32 North Range 119 West of the 6th Principal Meridian,
Wyoming.
Said real property was originally conveyed to J. REED BROWN and
JOYCE BROWN, husband and wife, by Warranty Deed dated August 20,
1963, and recorded in the Office of the Lincoln County Clerk and
Ex-Officio Register of Deeds on August 30, 1963, in Book 62PR at
Page 315.
4. At the time of her death my wife jointly owned certain
other real property with me, said real property being located in
the County of Lincoln, State of Wyoming, and more particularly
described as follows:
SW~NW~, Section 34, Township 32 North Range 119 West of
the 6th Principal Meridian, Wyoming.
Said real property was originally conveyed to J. REED BROWN and
JOICE BROWN, husband and wife, by Warranty Deed dated September 27,
1971, and recorded in the Office of the Lincoln County Clerk and
Ex-Officio Register of Deeds on September 30, 1963, in Book 95PR at
Page 425.
2
000759
5. By reason of my wife's death, I am entitled to sole
ownership of the above-mentioned real property.
DATED thl' S :1! ¡t..-day of f
-'< ¿p 1)/'6 .I ¡ 8.?"[ ,/') -~f-
I
, 2007.
¡J tfb-J 0>u7</Y1_
J. /!EED BROWN
SUBSCRIBED AND SWORN to
f)þ' frJ day of Me) l ¡ -t?v'Yl b..ev
and acknowledged before me this
, 2007, by J. REED BROWN.
WITNESS my hand and official seal.
M" co.mmis~ion.EXP. ires:
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~. JJll-l'l L\ LUÇÂJ\'j-ûLt ì
Notary Public
,.' -',·~~~ ,.-A:<I:_~",....ø:"V"'\.;I"~.\..~~
HEATHER WARREN
County of
Lincoln
NOTARY PUBLIC
" State 01
Wyoming
My Commission Expire3 December 15, 2010
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LOCAL FILE NUMBER -
1. NAME OF DECEDENT FIRST
STATE OF UTAH - DEPARTMENT OF HEALTH
8'5" CERTIFICATE OF DEATH
000760
LAST
STATE FILE NUMBER
3o,DATEOF DEATH (Mo"Day. V,) 3b,TlMEOFDEATHt.....'*"'1
MIDDlE
Joyce
4, DATE OF BIRTH I...., Doy, "'J
1B39
1,SOCIAL SECURITY NUMBER
Afton W omin _
Bb. NAME OF HOSPITAl, NURSING HOME OR OTHER FACILrTY
(If out.1de . far:illty, give ./raala_.. of_lion)
Dixie Regional Medical Center
e. SURVMNG SPOUSE(' wIf..gIve maiden "11m')
St. George Washington J. Reed Brown
10. ~R~~~~Em 1,. MARITAL STATUS 12.. =~~rJ~~ g;,Cg:~~~~"\~":I:.':::).,_ dOl1ll 12b, KIND OF BUSINESS OR 'NDUSTRV
ARMED FORCES? 0 1, Neve, MBrried 0 3, WldowBd
0'. V"1K!2. No ŒJ2. Merried 04, DIvorced
130, RESIDENCE - STR ET AND NUMBER
Education
30. COUNTY
13d. STATE
356 Monroe
13.. INSIDE CITY 13/. ZIP CODE
LIMITS?
00 ,. V..
02,NO
Afton
14':~,D~~~NT OF HISPANIC OR/GIN? 0 ,. v.. E9 ,2. No
O',Mo_n 0 2.Cubo"
o 3. Puerto Rlcen 0 4. Other (Specify'
Lincoln
15, RACE· Black, Whllo. Am,
Indian (1r1Þe may be entered).
J.pan..o, .Ie. (SpocII'¡)
Wy
18. EDUCATIONI_"",_..
-__ _ryor
Socondory(1).12) CoIIogo(13-18
or 17+)
83110
White
18. MAIDEN NAME OF MOTHER (Flnl, _. LaJl)
Nellie Theodosia Llo d
16
PARENTS
11. FATHER'S NAME (FIrJ/. _.. L..t)
Samuel ROberts, Jr.
18. NAME, RELATIONSHIP AND MAILING ADDRESS OF INFORMANT
~ ~~~5ìF·~ ~Pö'S?nON . Jt,- 21~1>À~E OF eisp<>srriõN 21b. PLACE OF DISPOSITION (nJIM of cemetery, 21c. LOCATION. City or Town, SIIiIe
cnmatory, ør oth.,. place)
INFORMANT
01. Entombmonl 0 2. Donollon 0 3, Other
o 5, CtemllIIon 0 8, RllmOVol
2003 Afton City
3, LICENSEE NUMBER
112551
Cemetery Afton, WY 83110
2., FUNERAL HOME (Name and address)
Spilsbury & Beard Mortuary
110 South Bluff St.
St. George, UT 84770
_toln,_
I Solwoen Onset And
Dooth.
I
05, NON·USER
33.. WAS AN AUTOPSY 33b. WERE ALlTOPSV
PERFORMED? FINDINQS AVAILABlE
PRIOR TO COMPLETION
Of CAUSE OF DEA1It7
o e. UNKNOWN
IF USER
01.V.. ŒJ2,No o 1. V.. o 2. No
!!II. N...... 0 a, _onl
o 3.Sufdd8 0 4.Ifomlcldo
o 5. ~~~::r'"od 0 e. ~~~:'1Ion 35g, DESCRIBE HOW INJURV OCCURRED(O_ Nquenco 0_
="Il:'
dr'W~~ p8~':'" or pe~.ltrlBn,
woo
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This ist(;~~rtify that this is a true copy of the certificate on file in this .office. This certified copy is issued
under authority of section 26-2-22 of the Utah Code Annotated, 1953 As Amended.
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RECORDS
By ~ L-.
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