HomeMy WebLinkAbout938798
AFFIDA VIT OF SURVIVORSHIP
000875
TERRIL YN THURMAN, of lawful age and being first duly sworn upon her oath deposes and states
as follows:
1. That TERRIL YN THURMAN is a person with personal knowledge of the facts hereinafter set
forth;
2. STEWART H. THURMAN and TERRIL YN THURMAN, husband and wife, held interests in real
property hereinafter described as tenants by the entireties. On August 19,2007, STEWART H.
THURMAN passed away in Bonneville County, State ofIdaho, thus ending such tenancy.
3. Said property became the property of TERRIL YN THURMAN, as her sole and separate. property
the property address of 467 First, Grover, WY, 83102, known by its legal description as
beginning at the Northwest Corner of the Southeast Quarter of the Northeast Quarter (SE1/4
NE ¥4) of Section One (1), Township Thirty-two (32) North, Range 119 West of the 6h P.M,
Wyoming, and running thence 10 rods East; thence 16 rods South; thence 10 rods West;
thence 16 rods North to the point of beginning. Together with all water rights, mineral
rights, improvements and appurtenances thereon situate or in anywise appertaining
thereunto. Subject, however, to all reservations, restrictions, exceptions, easements and
rights-ol-way of record of in use.
Together with all other rights appertaining thereto.
4. This affidavit is made in support of the transferring of real property to TERRILYN THURMAN.
5. Further affiant sayeth not.
RECEIVED 5/6/2008 at 4:15 PM
RECEIVING # 938798
BOOK: 693 PAGE: 875
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
~d-,-'~ ~~n_ /
TERRIL YN HURMAN
STATE OF IDAHO
)
)
SS
COUNTY OF BONNEVILLE
On this January 10, 2008, before me '''')''\,C- ~L\ S J .c;;L...z..- , personally appeared
TERRIL YN THURMAN, known or identified to me Ear Pffived to me on the ðfttfl-e£.
,- ---* to be the person whose name is subscribed to the within
instrument, and acknowledged to me that she executed the same.
~ ~ ~ My Commission Expires: ,..., 1 <C'" I ~ D ':5
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STATE OF IDAHO
ØOOB76
000881.'
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
DATI FlLID BY SrATE REGISTRAR:
Slale 01 Idaho
CERTIFICATE OF DEATH
~)-Î
STATE FilE NO.
Olf..:A~~r:I~ ::U~::.;I!~~~~A'g[~~:O;::::I\~~.DI~:'';7~'::'t~~:~~~o~:;~~ ~I\''1 Local Reg. No,
* 1. DECEDENTS LEGAL NAME (Include AKA'. If enYllFlrll, Middle, LillI. Sullllt) Z. SEX 3. SOCIAL SECURITY NUMBEFI
TYPI OR
.RtNT ..
~"M,I¡NÐfT
_'-ACt!: I'ft(
00 HOT un
ÆlT ".. ftþ
:5
~
5. DATE OF BIRTH (MoIDayIYr)
'1;
~'"
O··IIEN
It1
c:
:5
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æ
~
~
'C
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J
69
1938
_ Afton, _l:!yominL--"
7e. rrv OR TOWN
(Vur.)
-8 AT
\
\
'g. INSIDE ëifY"'-
LIMITS?
X! Yes [1 No
'OA
INITRUCnoN8
...
HAND800KI
Idaho
AN
1485 Juni er Driver
8. A AL STA US AT ME Of' D A
83404
NAME (II wile. Olve me den nlmel
Qi Merrlttd 0 Mømed. but stlpørllled 0 WIdowed I] DIvorced [] N,y.r ~rrlød
I .. A S N M ( I, Middle. Lell, Sum_,
:~:~~S? Stewart McCombs Thurman
6Q Yea 12.. MOT1-4ER'S MAIDEN NAME (Flrll. Middle. Lasl. Suffllll
o No Adell Hum
I. IN ORMAN NAME ype or p nl
o Unknown
L~~ 81RfH~ëA~E {Sllle. Terrilõiÿ7õff:õitÏ¡gn-ëõunlry) --
Wyoming
12.b. BIRTHPLACE ISllle. Terrllorÿ:- or Fõf8KJn Country)
lie, ZIp
Terri Lyn Thurman
*14.ME 0 0 DSP smaN
fj¡! BuÑI 0 CrlmlllDn
o Donation 0 Enlombmenl
6ò Aemavll from Idlho
00"""1
171. NATU
FUNERAL FACILITY
22. C OF DEA
Bonneville
21. TIME PRONOUNCED DEAD
__-.-£J_~}9_._~ Augu~tn l~~~______Q~3.º.
21, CAUSE OF OEATH
PART I, Enler Ihe ~ -.. dl.es,e" In/un", or complicallDnI _ -thai dlrlclly caulld thl dealh. 00 NOT enllr terminal evenll luch 81 caftflec
an·..I, "'øøltllOry arr'II, or venlrlcular Ilbrfßøllon wUhoullhowlng Ihl eUoIogy. 00 NOT ABBREVIATE. Enler only onl CIU,. on a line: .
IMMEDIATE CAUSE IAneI k.r C""OI\A~\
c...... or condfllon .... ~
reBultlng In dealh DUE TO lor.. . contlq~' 011:
Approxlmall Inlervll:
0018110 Dellh
7...... r/lu,,/
Sequenllally 11,1 condlllons,
" Iny. Ie.dlng 10 Ih. caul.
hied on IIn. I. Enlllr Ihl
UNDERLYING CAUSE
LAST (dile"l or Injury
Ihlllntllaled Ih. IVlntl
rellUfling In delllh)
AR II. nl8r
b.
DVETOIOI'It.conlequ.nc:eoll:
"'>
DUE. TO lor 1111 con"qv'~ 01);
d.
bUI nol r88ulllng In Ihe underlying cause given In Peril
28a. WAS AÑ'Ãvrops'f ; 28b. WEÄË-Äl.ffi>PšVFiÑÕÏÑÕŠ-
PERFORMED? AVAILABLE TO COMPLETE
THE CAUSE OF DEATH?
c: Ves 0 No
28, DID oaACCO USE
CONTRIBUTE TO OEATH?
o Vea rJ Probably
(]YII' ~No
r.J Nol pregnlnl. but pregnanl "3 dlY' 31. MANNER OF DEATH
10 1 year before dealh ~alural 0 Homicide
o Unknown 11 pl1lgnenl within lhe pssl I J Accldenl 0 Pending Inveallgallon
yeat 0 Sulcidl Ll Could "01 bll dellrmlned
34. PLACE OF INJURY fDICede",'1 home. larm. ,Ireel, co"'lrucllon ,1111. 35. INJURV AT WORK?
nursIng home, flsleuranl. Joresl. elc.)
.._~.{~-~~ -.. ..._.__.._---_.~.. .--.-"..---.-.--.
."..----¥.-.---.
r:'i YIII
IJ No
ZIpCodll
StBle
Slrlel Ind Number or .LoC811oo Äpllrlmenl Number
37. DI!.SC 19 H W INJUFt ARED. IF TRAN PORTATIÕÑÏÑJURY. BTATE THE TYPEIS) OF VEHICLE'S) INVOLVED IAulomoblle. pickup. moÎorcYCII. AT\.'. bicycle. elc.)
SPECIFY WHICH VEHICLE DECEDENT OCCUPIED, II applicable
WDu.mWAI
DUI! TO OTHER
ntAN NATURAL
CAU91[Ø.
THI CORONE"
MJlII
COMPLET'R N«)
SION""
CI"T1"CATI
TRÄÑiPORTATION ;3iï: WAS OECEDEÑT: U DriŸëiiõp-eralor O' Pssaenger:5ä-b.-WHÃTSÄFEt'{oEvtcë¡SlõiffÕËêËÕËÑr USElEMP(ÕŸr--·-· ---
INJURY ONLY I 0 Pedeslrlan 0 Olher (Specl I ' 0 SIal Bell 0 Child 581ely seal U Helmel 0 Air beg I.:ì N.one 0 Unknown
398. CERTlAER (Check onty one. bued on oHlclal clpaclly lor Ihll centrlcala) 3gb. LICENSE NUMBER
6a PHYSICIAN 0 PHYSICIAN ASSISTANT fl ADVANCED PRACTICE PROFESSIONAL NURSE
. To Ih, b,al 01 rrr¡ knowledgll. de.lh occurred allhe lime, dele, and place, and due 10 Ihe l1tJYrIf caus.(aVmanner Ilaled.
o COAONER
. On lhe bul, 01 eMlmlnallon and/or Invøsllgrll~n, Jrt my opIrJlon, dealt, occumtd allhe lima. dala, ,nd place. IInd due 10 \he ClUIl8(S)
Ind mannlr lUlled. ~~ l,L-. A _IÎ
Slgnlture Ind 'T1l1e or C.rtlfler ~ - ' / '"Y. !
31 AM ADORES. ND ZIP CODE e,ga FIER (Typl ot prlnl) --''''---- ._._._..__._._'u____· --- .--.- .--.-
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3Bc. OAT sjèfNeo-----
C--JJ..-,3:::.lJ~
MM DO YYYY
Christian T. Shull M.D.' 2330
83404
4Db, Aï'ËšIGNED
---1_'_
MM DD VYYY
1.1b. DA~~GNe[)
..LJ1i¡22.J.2.ML
MM DD YYYY
This Is a true and correct reproducllon of the document officially registered and placed
on llie with the IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS,
DATE ISSUED: {lLf£ì¡{(!vI 7? '1 zœ1
This copy not valid unlass pr!pared on engraved border
displaying state seal and signature of the Registrar,
~7~
'. JANE S, SMITH
STATE REGISTRAR
(24hr)
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