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RECEIVED 4/22/2008 at 9:47 AM
RECEIVING # 938421
BOOK: 692 PAGE: 519
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
THE STATE OF WYOMING
)
)ss.
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000519
COUNTY OF LINCOLN
MARVIN M. STONE, being first duly sworn upon his oath, deposes
and states as follows:
1. On the 5th day of March, 2008, my wife, VERA R. STONE died,
as is evidenced by the official certificate of death attached hereto
and incorporated herein by this reference.
2. At the time of her death my wife jointly owned certain real
property with me, said real property being located in the County of
Lincoln, State of Wyoming, and more particularly described as
follows:
Lot 14 of Block 1 of the Lincoln Heights 2nd Subdivision
to the Town of Kemmerer, Lincoln County, Wyoming as
described on the official plat thereof.
3. Said real property was originally conveyed to MARVIN M.
STONE and VERA R. STONE, husband and wife as tenants by the
entireties, by Warranty Deed dated July 22, 1998, and recorded in
the Office of the Lincoln County Clerk and Ex-Officio Register of
Deeds on August 24, 1998, in Book 416 at Page 186.
4. By reason of my wife's death, I am entitled to sole
ownership of the above-mentioned real property.
\ C'J,U'\
DATED this -Ì1L- day of
000520
\ A-\~\J1 ~ ~
/r(~,/Þ1/p
MAR IN M. STONE
, 2008.
SUBSCRIBED AND SWORN to and acknowledged before me this \1$'-\1-\
day of \1.,'Jl,\~ , 2008, MARVIN M. STONE.
WITNESS my hand and official seal.
My Commission Expires:
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2
CERTJFICATEÐF DEATH ",
State/File Number: 20080,02815 ..,
_.
Vera Ruth Stone
000521.
DECEDENT INFORMATION
------
Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address: \ I
March 5, 2008
Murray
74
Rushville, Nebraska
No
Marvin M Stone
Own Home
Kemmerer, Wyoming
Evelyn Gertrude Gilmore
Intermountain Me~.!çal Center
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
I
12:18
Salt Lake
January 26, 1934
Female / ./
M~tried
Homemaker
8th Grade or Less
Vernon Ezra Griffin
Hospital Inpatient
INFORMANT INFORMATION.
Name: Marvin M Stone<)(.: .' ". Relationship: RüSband
Mailing Address: 1327 Lincolg;Heights Driye; Kerrll;l1erer, Yyyoming 83101' ./
DISPOSITION INFORMATION/ ,; ... ....
Method of Disposition: Burial/Removál.. .,' ", ..' ,. . .... Date ofDisposition: March 8,2008 ;
Place of Disposition: South; Linçplh ,Cemetery, Kemmerer; WYOmi~~"
FUNERAL HOME INFORMATION . ,.' . ,. ,... ." ,. . ..... . .... . .'.
Funeral Home: Jenkins-Spffe·MortL.i~ry- .Murray... .... '" '. >
Address: 4760 South State Street, Salt Lake CitY,LJt~h.84107
Funeral Director: R?ger K "'{i!cox . ..... . .' .. I .' '. .
/
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".'1"
MEDICAL CERTIFICATION. '.' I ., .... .' '.. ,.,. .......
Certifying Physician: .? L~.~.,§u~ke MD, 516~ s~.CottonwoodStreet, Ml.lrraYiUt~~84157
i '. .... ,
CAUSE OF DEATH.. __', .
Acute MyocardiallnfarctiÓhrOnset: '18 Hours]
Tobacco Use: LJnknown if User \
Medical Examiner Contacted: No Autopsy Performed:N()
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Manner of Deélth:'Né tural
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March 13, 2008
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This is an exact reproduction of the document registered in the Statè'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 County/District Health Officer.
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!~~~IMMMlwmD·· ~d~
, 6 J. 5 6 6 '7 J. 0 * Director/Health Officer
County/District Health Department
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Barry E. Nangle, State Registrar
Office of Vital Statistics