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AFFIDAVIT OF SURVIVORSHIP
STATE OF WYOMING )
)ss.
COUNTY OF LINCOLN )
RECEIVED 2/7/2008 at 10:03 AM
RECEIVING # 936789
BOOK: 686 PAGE: 135
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
VERD B. ERICKSON, being first duly sworn on oath deposes and say:
0001.35
1. That Verd B. Erickson is of adult age and is the surviving husband of Patricia
Florence V. Erickson, who died October 26th, 2003, in Rexburg, Idaho, as hereinafter more fully
appears.
2. That by a Warranty Deed dated June 14, 1974, and recorded July 23, 1974, in the
office of the Lincoln County Clerk in and for the County of Lincoln, State of Wyoming, in Book
113 PR, Page 443, Emily B. Erickson (a/k/a Emily Erickson) conveyed to Verd B. Erickson and
Patricia V. Erickson, husband and wife, as tenants by the entireties, of P.O. Box 654, Afton,
Wyoming, 83110, Lincoln County, State of Wyoming, the following described real estate situated
in Lincoln County, State of Wyoming, to-wit:
NWIj.¡NWIj.¡ of Section 13, T3IN, RII9W, 6th P.M., Wyoming, containing 40
acres, more or less.
TOGETHER WITH all improvements, appurtenances, water and water rights, ditch
and ditch rights, thereunto appeliaining;
'.-<
SUBJECT TO reservations and restrictions of record.
3. That Patricia Florence V. Erickson died on the 26th day of October, 2003, in
Madison County, State ofldaho, and thereupon, the certificate of her death was duly filed with the
State of Idaho and made a matter of record in said office, and a certified copy of said certificate is
attached hereto and made a part of this affidavit.
4. That upon the death of Patricia Florence V. Erickson, as aforesaid, the joint
tenancy created by the aforesaid deed was terminated, and Verd B. Erickson, surviving husband,
became vested with all of his right, title and estate in the above property.
, fLt,
DATED this ls2.:. day of February, 2008.
~_A £~~
Verd B. Erickson
0001.36
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It ,sUBSCRIBED AND SWORN to before me by Verd B. Erickson this K day of
re~iW-t"a.t-' 2008.
County of
Lincoln
State of
Wyoming
~~
NOTARY PUBLIC ""'
BECKY BARBER· NOTARY PUBLIC
My Commission Expires August 31, 2010
2
STATE OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL S!ATISTICS
000137
Date Filed
CERTIFICATE OF 'DEATH
NOVEMBER.. 10,.2003 . State FileNo.
2003-08369
'-...
OECEOENT . LEG<\L N'\ME
PATRICIA FLORENCE V. ERrCKSON
SEX
-----
SOCIAL SECURll'Y NUMBER
AGE
DATE OF BIRTH
FEMALE
67 YEARS
SEPTEMBER 12, 1936
BIFlTHPLACE
PLACE OF RESIDENCE
LONG BEACH, CALIFORNIA
/MRlTALSTATUSATTIMEDFDEATH '
.~
AU¡:WRN, WYOMING
N'\ME OF SURVIVING SPOUSE (If 1'0. "",Idon "''''''1
VERD B. ERICKSON
WAS DECEDENT EVER IN
U,S. ARMED FORCES?
NO
MARRIED
fATHER· N'\ME
\,
BIRTHPLACE
CLARENCE KILBY VAN NOY
WYOMING
MOTHER· /MlpEN N'\ME
CHRISTINE /ËULA HOOKUM
BIFlTHPLACE
TENNESSEE
." METHOD OF DISPOSITION
FUNERAL SERVICE liCENSEE
REMOVAL FROM STATE
GARTH E. FLAMM
. ,
NAME AND ADDRESS OF FUNERAL FACILITY
FLAMM FUNERAL
DATE OF DEATH
IDAHO
CITY,TOWN OR LOCATION OF DEATH
COIJN1Y OF DEATH-
REXBURG, IDAHO
MADISON
RENAL FAILURE WITH SEPSIS AFTER SIGMOID COLECTOMY
APproJdmate IntBryel Between
Onset and Death
DUE TO (or 8. . C9nliequenc:e of):
"b'MËTASTATICCOLON CANCER - SIGMOID COLON
DUE TO (Of 8' . tonHquence of):
ç.
DUE TO (or a!-AI' consequence of):
d.
,OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but nol re8Ulting in the underlying ceu,", given eboye
NONE STATED
(,
WAS AN AlIfOPSY
PERFORMED?
NO
\
M<\NNER OF DEATH
,
NATu'RAL
N'\ME OF CEFlTIFlER
TITLE
DWAYNE M HANSEN, M.D.
CORONER SUBSEQUENT CERTIFICATION IF NECE
PHYSICIAN
\
I
!
DEsCRIPTION OF fDN INJURY OCCµRÆD
'\
This is a true and correct reproduction of the document officially registered and placed
on lIIe with the IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS.
,
~T~~X~
. JANE S. SMITH
ST ATE REGISTRAR
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JA~UARY 23, 2008