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Home My WebLink About935917 AFFIDAVIT OF SURVIVORSIDP STATE OF WYOMING ) ) ss. ) 0.00550 COUNTY OF LINCOLN I, JOHN R. ROSAS being of legal age and first duly sworn, deposes and says as follows: 1. That Kathleen Rosas, the decedent mentioned in the attached certified copy of the certificate of death, is the same person as Kathleen Rosas named as one of the parties in that certain Warranty Deed dated April 16, 1976, executed by Lucio C. Rosas and Elvira L. Rosas, husband and wife, to John R. Rosas and Kathleen Rosas, husband and wife, as tenants by the entireties, recorded as Instrument Number 477669, on April 19, 1976; in Book 125PR at Page 345, of the Official Records of Lincoln County, State of Wyoming, concerning the real property situated in the County of Lincoln, State of Wyoming and described as follows: Parcel #68, being a portion of Tract 50 of the Resurvey, lying within th e unplatted portion of the Town of Diamondville, beginning at Comer 1 of Parcel 68, which is also Comer 1 of Parcel 69, said comers being N 19" 50'30" W, 1544.1 feet from Tract Comer 3 of Tract 46 and Tract Comer 8 of Tract 38; thence N 52"14' W, 124.7 feet to Comer 2; thence N 37"46' E, 100.0 feet to Comer 3; thence S 52"14' E, 124.7 feet to Comer 4, which is also Comer 2 of Parcel 69; thence S 37"46' W, 100.0 feet to Comer 1, the point of beginning, containing 12,470 square feet, more or less, together with all improvements and appurtenances thereon situate or in anywise appertaining thereunto, SUBJECT, however to all reservations, restrictions, exceptions, easements and rights-of-way of record or in use, 2, That Kathleen Rosas, the decedent mentioned in the attached certified copy of the certificate of death, is the same person as Kathleen Rosas named as one of the parties in that certain Quitclaim Deed dated September 9, 1988, executed by The Pittsburg & Midway Coal Mining Co" a Missouri Corporation to John R. Rosas and Kathleen Rosas, husband and wife, as joint tenants, recorded as Instrument Number 695371, on November 14, 1988, in Book 267PR at Pages 162 and 163 of the Official Records of Lincoln County, State of Wyoming, concerning the real property situated in the County of Lincoln, State of Wyoming and described as follows: A 30 foot strip of land in Tract 50 of Johnson and Jaeckles resurvey of Section 23, T21N, R116W, 6th P,M., contiguous to Parcels 67 and 68 of the replat of Diamondville, Wyoming dated August 31, 1942 on file with the County Clerk and Ex-Officio Register of Deeds for Lincoln County, said strip being described to-wit: Beginning at an aluminum cap set N 11 43' W, 1733.4 feet from the southeast comer of Section 23, also being Comer No, 1 of said Parcel 67; Thence N 37 46' E along the easterly boundary of said Parcel 67, a distance of 100 feet to an alurninum cap set at Comer No.4 thereof; Thence S 52 14' E, a distance of 30 feet to an aluminum cap set at Comer No.3 of said Parcel 68; RECEIVED 12/31/2007 at 1 :46 PM RECEIVING # 935917 BOOK: 682 PAGE: 550 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY Thence S 37 46' W, a distance of 100 feet along the westerly boundary of said parcel 68 to an aluminum cap set at Comer No.2 of said Parcel 68; 000551.- Thence N 52 14' W, a distance of 30 feet to the point of begirming being said Comer No.1 of said Parcel 67, bounding 3000 square feet, rnore or less, 3. That KatWeen Rosas, the decedent mentioned in the attached certified copy of the certificate of death, is the same person as Kathleen Rosas named as one of the parties in that certain Warranty Deed dated June 3, 1991, executed by Homer M. Tyler, a widower to John R. Rosas and Kathleen Rosas, husband and wife, as tenants by the entireties with rights of survivorship, recorded as Instrurnent Number 733388, on June 4, 1991, in Book 297PR at Page 288 of the Official Records of Lincoln County, State of Wyoming, concerning the real property situated in the County of Lincoln, State of Wyoming and described as follows: A parcel of land situate within the NE\4SE\4 of Section 23, Township 21 North, Range 116 West of the Sixth Principal Meridian, Lincoln County, Wyoming, and more particularly described as follows, to-wit: Begirming at a point North 11°43 ' West, 1733.4 feet from the southeast comer of said Section 23; thence North 52°14' West, 90 feet; thence North 37° 46' East, 100 feet; thence South 52 °14' East, 90 feet; thence South 37° 46' West, 100 feet to the point ofbegirming. 4. That Kathleen Rosas, the decedent mentioned in the attached certified copy of the certificate of death, is the same person as Kathleen Rosas named as one of the parties in that certain Warranty Deed dated February 11, 1999, executed by Frank W, Klun, Trustee ofKlun Family Trust dated November 22, 1991 to John R. Rosas and Kathleen Rosas, husband and wife, as tenants by the entireties, recorded as IhstrumentNumber 857121, on March 4, 1999, in Book 426PR at Page 841 ofthe Official Records of Lincoln County, State of Wyoming, concerning the real property situated in the County of Lincoln, State of Wyoming and described as follows: A parcel of land embracing portions of Tracts 46 and 50 of Johnson and Jaeckles resurvey of Section 23, T21N R116W ofthe 6th P,M., within the NE\4SE\4 of said Section 23, Lincoln County, Wyoming described to-wit: Begirming from a point N 15°27'59" W, 1869.26 feet from the Southeast comer of said Section 23, also being the Southwesterly comer of Parcel 66 ofthe replat of the Town of Diamondville; thence S 57°13'49" E, 90 feet to the southeasterly comer of said Parcel 66; thence S 51°51'53" E, 207.40 feet to a point on the southerly line of Parcel 68 of said replat; thence S 32°02'34" W, 364.87 feet, to the southwesterly comer of Parcel 63 of said replat; thence N 41"58'26" W, 310.74 feet; thence N 32°31 '04" E, 302.46 feet to the point ofbegirming. 5. That Kathleen Rosas, the decedent mentioned in the attached certified copy of the celiificate of death, is the sarne person as Kathleen Rosas named as one of the parties in that certain Warranty Deed dated July 11, 1996, executed by C, R. Galloway to John R. Rosas and Kathleen Rosas; 2 00Ù552 husband and wife, as tenants by the entireties, recorded as Instrument Number 822912, on July 12, 1996, in Book 335PR at Page 485 of the Official Records of Lincoln County, State of Wyoming, concerning the real property situated in the County of Lincoln, State of Wyoming and described as follows: Parcel 66 of the replat of the Town of Diamondville, Lincoln County, Wyoming, as described on the official plat thereof, ortparticularly described as follows: Beginning at a point N 13°33' W, 1802.9 feet from the southeast comer of Section 23, T21N, Rl16W of the 6th P.M., Lincoln County, Wyoming and rurming thence N 37" 46' E, 100 feet; thence N 57"30' W, 90 feet; thence S 32°30' W, 100 feet; thence S 57"48' E, 90 feet to the place of beginning. 6. That I am the same John R. Rosas mentioned in the above referenced Deeds and thereby am a person interested in the effective property or the title thereto and pursuant to § 2-9-102 VI.S. (1980) hereby make the death a matter of record and certify that upon the death of Kathleen Rosas, her previous estate in the property was terminated. 7. That the certified copy of the certificate of death indicates that Kathleen Rosas died on November 21,2007 in the City of Salt Lake City, County of Salt Lake, State of Utah. Dated this 31 day of December, 2007. ~ ¡¿ J;¿~ JOHN R. ROSAS STATE OF WYOMING ) ) ss, COUNTY OF LINCOLN ) . . ~ Subscnbed and sworn to before me by John R. Rosas, thIS 3/ day of December, 2007. ;"~~ÕÈ;;mAA.HÃ.;, ~~,~;.f~,· fÂRy-plip,'Lìc-~ ¡ COUNTY OF (J);;'.( ":\ SiNE OF t ~ LINCOLN ,.~.' ,.y 'Nyœ¡:NG. ? ~~~!~r~ÚdÉ/!ÁZ.£1J;,;,:,"t £)" /,.1) r? () II If ,y¡J\ pnJ NOTARY PUBLIC My Commission Expires: ,,-~!..J~b{)/j 3 CERTIFICATE OF DEATH State File Number: 2007012926 000553 ~--- '"", Kathleen Rosas DECEDENT INFORMATION Date of Death: City of Death: Age: Place of Birth: Armed Services: Spousa's Name: \ Industry/Business: Residence: Mother's Name: Facility or Address: \ November 21, 2007 Salt Lake City 53 Kemmerer, Wyoming-- No John R Rosas Domestic Diamondville, Wyoming Jewell Lorraine Mills University of Utah Hospital '-" Time of Deatt'í: County of Death: Òate of Birth: Sex: Marital Status: Usual Occupation: Education: Father's Name: Facility Type: 00:12 Salt Lake August 31,1954 Female Married Homemaker Some College but No ~egree Robert H Krall Hospital Inpatient INFORMANT INFORMATION Name: '- John R Rosas " Relationship: Mailing Address: 20 Little Canyon Road, DiamondviHe, Wyoming 83-116 ~ ',., Husband \ \ ' DISPOSITION INFORMATION> " '...,' Method of Disposition: Cremation" ._<Date9fDisposition: Nove":!þer27,2007 Place of Disposition: Utah Funeral Directors Cremation Center, South Jord~I1, Utah'? ,J, FUNERAL HOME INFORMATiON Funeral Home: Crandall FÜneral Home Address: PO Box 6, 105 East Center Street.Kama~,lJt~h84036 Funeral Director: William W Ball ' ,. ' , ., MEDICAL CERTIFICATION 'i:\ / Certifying Physician: JasQ('LScþ\'iartz MD, 5Q.North Medical Drive, Salt CAUSE OF DEATH .', Fulminant hepatic failure [Onset: 7 Days] Malnutrition ',,< Tobacco Use: Unknown if User , , c Medical Examiner Contacte(j:No;2Autqpsy Peñormed: Yes November 26, 2007 \ \ This is an exact reproduction of the ~ocument registered in the State Office of Vital Statistics. Security features of this official document include: Intaglio Border, V & R images in top cyclolds, ultra violet fibers and hologram image of the Utah-State Seal, over the words "State of Utah". This document displays the date, seal and signature of the State Registrar and the CountylDistrlct Health Officer, ~ê/~ Barry E. Nangle, State F;legistrar Office of Vital Statistics 1IIIIIIInm~I.11 1l~ * 0 6 ~ 5 4 7 3 3 6 * Director/Health Officer County/Distric( Health Department