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RECEIVED 2/28/2008 at 1 :50 PM
RECEIVING # 937245
BOOK: 688 PAGE: 165
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
êQQ165
In the Matter of the Estate of:
CAROL CmCHINSKY,
AFFIDAVIT OF SURVIVORSHIP
PURSUANT TO W.S. § 2-9-102
Deceased.
STATE OF WYOMING }
ss.
County of Lincoln }
I, Steve Chichinsky, being first duly sworn, do hereby state as follows:
1) I am an adult, competent to testify, and make the following affirmations based
upon my own best investigation, information and beliefs;
2) I am an interested person and make this Affidavit pursuant to WS § 2-9-102;
3) This affidavit relates to the following described parcel of real property situate in
the County of Lincoln, and State of Wyoming, more particularly described as
follows, and hereinafter referred to as the "Subject Property:"
Lot 1 of Salt River Cove Division No.1, Lincoln, Wyoming as described
on the official plat thereof
Together with and including all improvements thereon and all
appurtenances and hereditaments thereunto belonging. Subject to all
covenants, conditions, restrictions, easements, reservations, rights and
rights-of-way of sight and/or record.
4) The Subject Property was conveyed to Steve Chichinsky and Carol Chichinsky,
husband and wife, as tenants by the entireties, via that certain Warranty Deed
recorded in the Office of the Lincoln County Clerk, Lincoln County, Wyoming,
as document number 906200, in Book 578 of Page 173 on January 31, 2005;
5) That Carol Chichinsky passed away on the 20th day of December, 2007, and the
place of last residence of Carol Chichinsky was the County of Teton, State of
Wyoming. See Attached Death Certificate;
6) Following the death of Carol Chichinsky, Steve Chichinsky of P.O. Box 3827,
Jackson, Wyoming is the sole interest holder in the Subject Property.
FURTHER AFFIANT SA YETH NAUGHT.
Dated this
Is -H,
day of
hØ (( ¡J I/- R '1
,2008.
~
~
AFFIDAVIT OF SURVIVORSHIP
PJIIt! 1 012
}
ss.
County Of Teton }
The foregoing Affidavit of Survivorship pursuant to W.S. § 2-9-102, was subscribed, sworn to
and acknowledged before me by Steve Chichinsky, Affiant, on this 13 ~ day of
~ ,2008.
Witness my hand and official seal.
STATE OF WYOMING
ÜOO1.66
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AFFIDAVIT OF SURVlVORSmp
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