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Affidavit of Survivorship
000203
I, George E. Mitchell, being of lawful age and duly sworn according to law, upon
my oath, depose and state:
That under the date of July 17, 2000, for valuable consideration, Leisure Valley,
Inc., by deed of that date, which deed was duly filed of record in the Office of the
Lincoln County Clerk, on September 6, 2000, in Book 451PR, Page 583, conveyed to
George E. Mitchell and Joyce Rayetta Mitchell, as joint tenants, the following described
land, to-wit:
Lot 2002 of Star Valley Ranch RV Park Plat One 2nd Filing as platted and recorded in
the official records of Lincoln County, Wyoming
That by reason of said conveyance aforesaid, the said George E. Mitchell and
Joyce Rayetta Mitchell (husband and wife) as joint tenants, became the owners of said
real property, and title thereto vested in them continuously from the date of said
conveyance to the date of death of Joyce Rayetta Mitchell, on the 2nd day of December,
2007. That by reason of and upon the death of Joyce Rayetta Mitchell, title to the above
described real property vested absolutely in George E. Mitchell, as surviving joint tenant.
Affiant avers and certifies that Joyce Rayetta Mitchell is the identical party named
with George E. Mitchell in the aforementioned deed, whose death terminated her interest,
title and estate in said real property; and Affiant attaches hereto and makes a part of this
affidavit, a copy of the Official Certificate of Death of said decedent, duly certified by the
public authority in which said death certificate is a matter of record.
Dated this '1. ç- day of 9 ll./'-.
,2008.
ÐANDREW L. OLDHAM
NOTARY PUIUC STATE OF TWS
""-*1. cO..lnto. UPlREI:
"'~,OF~ 11 -07-2011
ati~
Notary Public
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. George E. Mitchell
----
State of /~04-. )
County of ÚJ~ ¡rr-... )
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Subscribed and sworn to before me, a notary public in and for said County and
State, by George E. Mitchell, this ~ 5 day of JeAv'! t.AA f Ý , 2008.
WITNESS my hand and official seal.
My Commission Expires: J J. l - ;;J.. 0 It
RECEIVED 1/29/2008 at 12:36 PM
RECEIVING # 936589
BOOK: 685 PAGE: 203
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Thi. Docu,,*,t I. be" ~ by
Rocky Mountain Title ,ftIU.... Agency
of LinCOln County .. . CØURTESY only
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1'J U Ind.eth)I..AST. d.
.i 1 ~~~':~~No~:~ 1~IGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING IN THE UNDERLYING
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ApproJdm.le Inl.rval:
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%~ROFDEATH
o AtØdllnt
:. 0 SuIdde
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o Peftdlng Inveillgell6n
o Cook! not be d.termlned
40.. DATE OF INJUR~ (Mo/DayIYr)
37, DID TOBACCO CONTRIBUTE
TO DEATH' '\
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OPIU~1y
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34. WAS AN AUTOPSY PERFORMED?
p.Yes,. II ~~.
~ :35:.WERE AI{TOPSY FINDIN~.S AVAlI.Al\'~ TO :"
: ;COMPLETE ~E CAUSE OF D.~TH? D:::,~',. O::No
3i.IF TRANSPORTATION INJU"Y.
SPECIFY:
o DrMtdOper.tor
o Paliili,.;", ,.
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38. ~ FEMALE:
il'Not preonln( WIIhtn pest ye.r
- g;#::~ ~~~~~nl wII:~'42:~~Y1 oi~~1h ··:U····
O"~ pregnenL bùt~gmmt ..~;<t.)'S loi1 ye.. it8fore ~
O..~øwnlfpregn~wllhlnlh.:P!l.II!I..)'4t"'·· .
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41. DESCRIBE HOW INJURY OCCURRED
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S457t89
This is to certify that this is a true and correct reproduction of the original record as record~d in this
off.ice~I.. sSlJed~nd~r aut'10rity ,?f Slilctic;m191iP~1 , Heêllttl & safety Qode;
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