HomeMy WebLinkAbout936858
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6010816405
STATE OF CALIFORNIA)
CO UNTY OF R I VfJl-S j(~ (... )
SS.
RECEIVED 2/11/2008 at 3:28 PM
RECEIVING #936858
BOOK: 686 PAGE: 299
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
~ G.-J /
I, Gale- L. Ueland, being of lawful age and first duly sworn according to law, upon
my oath, depose and state:
AFFIDAVIT TERMINATING ESTATE
000299
1. That I am of adult age, a resident of India, California, and the Affiant
herein.
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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 588PR on page 18 is recorded a Warranty Deed. The
Warranty Deed, dated the 9th day of June, 2005 conveys unto David M.
Ueland and Gail L. Ueland, Husband and Wife as Tenants by the
Entireties with full rights of survivorship the following described
property, to-wit:
See attached Exhibit' "
3. That said David M. :'Iand on the /d. day of c?t!~k: ~
.,'2I!JIJ Ç;., 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".
4. That by reason of death of said David M. Ueland and by reason of 2-9-
102 W.S. (1980), the decedents interest and title in said conveyance has
terminated and title to the real property conveyed thereby has vested
absolutely in Gail L. Ueland continuously since the death of the said
decedent.
FURTHER AFFIANT SA YETH NOT.
t.. -to .- 08'
Dated
State of ~~ .;\-
County of ~wi(.lt,~\o'O£
)
)ss.
)
The foregoing instrument was subscribed and sworn to me by Gail L. Ueland
this ~71-~' day of Feburary,2008
Witness my hand and official seal.
X~' E. L. PENTZ ~
... COMM,# 1693656
UI ~.... NOTARY PUBLIC· CALIFORNIA ~
~ 'I' RIVERSIDE COUNTY ..
'1 My COMM. Exp. SEPT. 14, 2010 I
...-vI\ ! .. ".,:...... J ~ . ~ ,.............................. ~ 9 ? . .... ~ 9..
~-
Notary Public
My Commission Expires: 11 - t Lf - "L..ð l D
Exhibit "A"
tlst/cs /
V IJ ~S-
Data of Slgnetura
wn causes. refer case to
DMINo:
Z006-""O",,49~~:: O..~l> '100
""'¡"~' V~·"
.c". ',;.:.--.. V,: ...,
::;::...... ...
.'......_.. ,",'......
H.. .... .....
","::,. .,....;....:::.......::.;.....
Mimbres Grällt
City of Death CoÍíntyofPQïih
lb. IF DECEDENT tS FEMALE· Give matden neme. CLøt nem. prl~}.~. ".m mirii...:)
4..AGE~1111 blrthd.,. (v.....)
72{
Sc.:COUNTRV OF SIRTM
' USA
8c. RESIDENctCO'UNTY
GRANT
8d. RESIDENCE STATE
NEW MEXICO
::~:F'NT' If u::u:~· 5jü'LÿIRi2onWDï934
s·~t54ENëAËÄÏLÕER Bwoëo
S.. RESIOENCE COUNTRY sr. RESIDENCE ZIP CODe " "'If. "IS RESIDENCE INSlDi CITY UMITS7
USA 8804;¡ç:J,!" 0 No
11. DECEDENTS RACE·~'" OM ~~__ ~tø:irt~~~:Ih. .cedent oon""'''
........or 10 b8: :','\,: ..'.,.. ""',, '''', ')' t
Gì White 0 8IàiOM·:Ót~r~~Am'~~n
LT Arnettca" tndlln or N~,~~.~ .
Speclf1 n.me of the T~bI(Î~:':"" .... .....
AIiIn IncI'-n q;~;::"J'~_~'~::, .... ":;:::'" 0 Kor.."
Chln_ I:L a.!Tiiaíi'/:"."O F1Ilplno
VJetnlmete C;;r;; N.~ HI~~ri'
Oth-: Allin
(Specify ;
Guemlnlln or OIlmorro' '}:"
Other Peolfla IIIM.r ISpectfy):""
Other (Specify):
9. DECEDEHrS ED~T10N . Check the bOJl,.1hal beit dlserib.':'.lhe hlCf'lIl'
de.,.. or levet of .cheol completed .t the·tlme, _of death.
8th JrHI or I...
9th· 12th arH« no dlploma!i: No.notSp.nl.h/HI.panIO¡~tlno
HIp M:tIooIlJ'IdUltl Of GED_completëd,,' 0 Ves. Spanish/HispaniC
Some cone.. Cf1dlt. but~_é; d...... 0 Ves, Mexlcan/Me.'cln American
Atsoctate de.,.. (..... ~;:AS) " . 0 V... Puerto RIcin
Bach.lo". de.,.. (...., ~'.AS~:iJs) 0 Ye.. Cube"
Masters de.,.e (..... MA~:'~. MEnl,¡:MEtfò' MSW/MBA) 0 Ve.. latino
Doclo..... I..... PhO. EdD)ö~:Prof"lIjon.1 d,..... 0 V... Other Hispanic Orllln
e. . MD DOS DVM llB JO'; f oth.r (Specify):
12a. DECEDENTS USUAL OCCUPATION ·lmIOI" Iype af wcrk doni dIIinf mOlt of WOftdng If I. Do not UN ,....d
....--. TEACHER
. MARITAl SA· At lime 0 death
II: Morriod
o Never Mimed
115. FATHER'S FULL NAME
ELMER JAMES UELAND
to. DeCEDENTS HISPANIC ORIGJN1 Cheelllhe box !hll bllt .lOIbN....1hIr 1'1, ~ Is
Spanllh'Hllp.uc/LaUono. Check !h. "NO· box H dtctdlnt II ~I SplMll.'Hl.,lI1icriLatino.
o
o
o
o
o
o
o
Ub. KIND Of BUSINESS OR INDUSTRY
EDUCATION
o Dlvore.d
o WIdowed
14. G'ÄrL SDRUM1JÕÑÏ)" n.m. (nlm. prior 10 n". m.,rllþ)
11. MOTHER'! FUU MAIDEN NAME - Give nlm. prior 10 nrat mlrYl,..
PEARL KINNEY . .
o
Unknown
171. INFORMANT. NAME (Fll'lt and L..I,
GAIL UELAND
170. INfDRMANTS RElATIONSHIP TD DECEDENT
WIFE
1!1'1'40RëÃËÃÎÎ.ÕREËmëðs....'MOORES ,,:NM, 88049
19. PlACl OF OISPOsmON - Name of Cern.".,. I Crtmld.oty or Oth., Place.
18. METHOD OF DISPOSITION
o Burial
JII Cremation
II Dlh.~S."II'y : Roadwa.1f'
CDMPlETE iN.lÛiwSËÇT1ÖN FOR ACCIDENT,
HOMIC~.9..~:,~WI.~I.D£ OR UNDETERMINED
32d. lOCATJON OF INJURV· (Add,.... ;~rj' SIe~.~...~!I?_.~~.J:::::: '::'
- PIC
Drlver/Optre~~::·. t:J:: ::;::.:.~....~",
""'"1_ '::. 0 . Othe $ tcl
PART I. Enler III. chlln of ewnll- di....... I~... or oomplloallon,· ...1 dncfV MIlled'" dull 00 NOT anter lermlnll MnlllUClh II........ ...1IIÞry:::-:::... :.::: Appro.tma InI8rvlt
....... Ibvkt. orWflticul. fIbrIIIalløn .11hovC Ihowing llIe e,,*lW. DO NOT.,.., 'Olel Age-. 00 NOT~. En_ only 0118 GlUM on alne. Add addIIIDn.an.. 0-1 to....
Ifn_....,.
~ ..
Arteriosclerotic cardiovascular disease
Du. to lor "' conaequ.ncI of).:
e
Sequentially IISI condition.. If any, 1.ldln,
to the CIUII IIlIed on line e. Enler the
UNDERLYING CAUSE (dll.... or Injury
th.t I"UNlted the evenls rllulUn, In death)
lAST.
..
Due to (or '1' conHquencl of):
Du. 10 (o, ... connquencl of);
· d~ '.
PART II. Enler other Silniric:anl condillons c:on.lri,buli."1 (o.diJ.t~ .~UI not retulUn¡ln the underl)'!"1 CIUse ,Iven In PART I.
Due (0 (or.. . consequence of):
°
Y.. 0 ProO.OI}'
No em Unk"own
a.WAUPSPERRD
No
U I
37b. IF VESt Specify Type of Proçedur.
3 T'f,)ìAT1õ9f P~9~1IÙ~~(~onWD"/Y"')
No
ì
!
o Not Prelnant. bul pre..,.nl 43 days to 1 year before death
o Unknown If preen_nt within 1 )'ear of death
38.. If PReOHA~rATtlt,4E,9MEÁM T\I,e,IIME Of DEATH ESTIMATED
LENGTH Of PREG~Nçy"fWEEKiI ),,: "",
39. CERTIfiED BY
o C.,tiro.d "",.'cl.n tJ
o Doctor or Osteopathy 0
III Orne. or Ihe Medlcallnvellillltor . d.
OMI/UHM
'0:"
408. NAME OF CERTIFIER IPlease t)'p. or print cle.rly):
· Trlb"i:A¿' h:Ø~.ty
· ~Ult~'Y'''U~hØ;lty
Othl!J~l$þëclty):
40b. ADDRESS OF CERTIFIER (PI..':~::~)'.~:~,;~(~ø.~(:::~~~.!y~ ,.:.
Ian Paul, MD
2134732
CERTIFIED COpy OF VITAL RECORD i.. .' ',' ',' ,'.' i
This is a true and exact reproduction of all or part of the dOc1iin~!J~i')
officially registered and filed with the New Mexico Vital '
Records and Health Statistics. Public Health Divisiou,
Department of Health.
CERTIFIER STATEMENT: On the ba,l, of ellemlnetion an
40c. SIGNATURE OF CERTIFIER
Signature Electronically Authenticated"
nlon. Ihl, death ol:curred lit Ihe lime. d.te end lice, .nd due 10 the cause, .nd manner stlled.
40d. DATE SIGNED IMonlh/Oa)'lYea,)
Oct 25, 2006
iiJ~£)~
State Registr~
DATE ,sJjMN J)) 'ð 2006
Exhibit "B"
00\>301.
Lot 5 of Emigrant Meadows Subdivision, I..incohl County, Wyoming as described on the official
plat filed OIl October 8, 2003 as instrument No. 894227 of the records of the Lincobl County
Clerk.