HomeMy WebLinkAbout938800
AFFIDAVIT OF SURVIVORSHIP
000878
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 TERRlL YN THURMAN, husband and wife, held interests in
personal property hereinafter described as tenants by the entireties or as joint tenants with
right of survivorship.
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3. On Au~st 19, 2007, STEWART H. THURlVIAN passed away in Bonneville County, State of
Idaho(d~ath certificate attached), thus ending such tenancy.
4. Said property became the property ofTERRILYN THURMAN, as her sole and separate property:
,
1998 Jeep Grand WagoneerVIN lJAGZ589S9WC231469
3 Bank ~f Star Valley cash accounts (account numbers omitted for security reasons)
Tog~ther with all other rights appertaining thereto.
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5. This af:Q.davit is made in support of the transferring of personal property to TERRIL YN
THURMAN.
6. Further affiant sàyeth not.
RECEIVED 5/6/2008 at 4:25 PM
RECEIVING # 938800
BOOK: 693 PAGE: 878
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
~T~~~~~
STATE OF IDAHO
COUNTY OF ~ONNEVILLE
On this Janu¡ary 10, 2008, before me ~~c...~<. \ '3 L~ , personally appeared
TERRlLYN THURMAN, known or identified to me (er-prð'Vecl--te-m-e-oo-the-oath-'of
------........;-.....-------".-),to be the person whose name is subscribed to the within
instrument, and acknowledged to me that she executed the same.
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~ ~-e * My Commission Expires: ~
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STATE OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
DATE PILED BY STATE REGISTRAR:
Stata of Idaho
CERTIFICATE OF DEATH
~)-
STATE FILE NO.
0HI.~~~~~~~.~=~~'.e~~:O::::J\':"U::::::=~~'~:~4~==I·1I1 Local Aeg. No.
* 1. DECEDENT'S L-=GAL NAME !Include AKA', II Iny} (Fir.,. MIddle. L8I1. sum.) 2. SEX 3. SOCIAl. SECURITY NUMIER
TYH OR
PAINT..
PMMAHIIHT
BLACK INK
DO HOT UI.
rn.T 1'1P "IN
,6
~
Dftl6gn Counlry)
5. DATE OF BIRTH (MoIOayIVr)
'õ
~ 69
~ ..
~ Idaho
~ A
~ 1485 Juni er Driver
.!I! ., ARITAL STATUS A T1ME 0 DEAT>I
¡¡:
~ Ga Mlrrled '0 Mimed, but ..peraled [J WkIowed CJ Divorced ~~~v.r married
~ 10. I.. 1'0 A ER'S HAM I. Middle. Lall, umx)
'äi ~~~~~s? Stewart McCombs Thurman
;a; 5<! ·Ye. 12.. MOTHER'S MAIDEN NAME (Fltsl, Mlddle.lall. Sutlb:)
âj DNo
J 3.. INFORMAN
ev..ra'
January 30~8
y
'OR
INSTRUmONa
""
HANOBOOKI
7g.1 TfV-- ..-
LIMITS?
XI v.. 0 No
[.1 Unknown ._ Te r r i L~~ B R£;0-~E Islale. Terrllory, or For~tgn-~-
"'_____ Wyoming :
12b. BIRTHPLACE ISlale. Tertilory. or ForeJgñ-Counhyj-
umber. City. lele, Jp
01
Terri Lyn Thurman
* 14. METHOD OF ISP smON
5iI Burt,1 0 Cremation
o 00n8llon 0 Entombment
6( Removal from Idaho
o Ot""( cty
17.. I NA
22. COUNTY 0 DEATH
Bonneville
26. TIME PRONQUNCED DEAD
("h,} August 19, 2007
'27, CAUSE OF DEATH·....-'--_.. \
PART I. Enler Ihe ~ --dllI.IIII, InJUriIS. or compllcallon. --Ihlt dll'8clly caused Ihe dealh. DO NOT enler lermlnalavenll lueh .1 cllrdlac
81T8SI. reapltB'ory arresl. or ventricular nbrtllBl10n wllhoul showing Ihe etiology. 00 NOT ABBREVIATE. Enler only one cause on a line: '
IMM.DIA~ CAUSE (Flnol JZ:....LOI\N;\
dIaB." at condition ....
r.8ulllng In d.alhl DUe TO lor I. I conaequenc:e of!:
0830,.._.._~~~~
Approximate InlelVel:
Onlello o.elh
7,...... ''IUv
:b.
OVE TO 101' Illconllquencl al :
,6
"'
Q
o
c.
DUE TO 101' II I COnllqul"Cl oJ ;
d.
29, D TOBACCO U E
CONTRIBUTE TO DEATH?
o Ve. [J Probably
30. IF FEMALE (Aged 10- 41:
o Nol pregnanl within paSI year
o Pregnanl alllme 01 del!llh
o Nol pregnanl. bul pregn8nl
wllhln 42 days 01 dBBlh
33. TIME OF INJURY
28a. WAS AN AUTOPSY I 28b. W~RE ÃUTOPSY FIÑÕINGS-'
PERFORMED? AVAILABLE TO COMPLETE
THE CAUSE OF DEATH?
[iVSI ~No [1 Yel ~ No
31. MANNER OF ~_....-.---..-._.~- .._-_.
f] Nol pregnanr, bul pregnant 43 days
10 1 yesr befofB deslh ~I!IIUfa! 0 HOmicide
IJ Unknown If pregnant within Ihe pasl I.J Accldenl [ Þendlng In"8IlIgallon
yesr fJ Suicide tl Could F10I be delørmlned
34. PLACE OF INJURY (Decedsn!'1 home. lann. slrael. conllruclJon slle. 3&. INJURY AT WORK?
\ nursing home. r88Iau(8nl. lorest, etc.)
bul nol resulUng in Ihe underfylng cause given In PaM I
n Ves
fJ No
_._._~2.4h()
.~._- ---_. ..--------.-.. .-...-.-----.-..
'" DUm WAI
DUR TO OTHER
mAN N....TURAL
CAUl!!"
1'HI: CORONIA
MIIII
COMI"&JIl! AND
liON THE
CIAnP1C....TI
eX:
w
¡¡: Street Ind Number or locallon Aparlmen! Number
i= 37. DESCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY. STATE THE TYPE(S) OF VEHICLE(S) INVOLVED l.4.ulomobll.. pickup, molorcycle. ATV. bk::ycle. ele.)
a: SPECIFY WHICH VEHICLE DECEDENT OCCUPIED, II oppl~lbll
W _
o ïïuNSPOÃTATION ;381. WAS DECEDEÑÏ'!1...TDrlverlOperäïõr-O Paslengar :3lib:-WHATSAFEfŸ-ÒEVICE(Sj DID DECEDENT USElEMP[õV7 ~-- .-- "--
INJURY ONLY , 0 Pedellrfan 0 Other (Speel ) , [] Seal Belt 0 ChIld ,.lelV seat IJ Halmel 0 Air bag D None 0 UnknC/Wfl
39.. CERTIFIER (Check only one, band on olllelal capecltv lor 11'111 cer1J1icale) 3gb. LICENSE NUMBER
õa PHYSICIAN . 0 PHYSICIAN ASSISTANT 0 ADVANCED PRACTICE PROFESSIONAL NURSE
. To Ihe be,1 of my knowledge. death occurred althe lime, date. and place. 8M due 10 Ihe IHhH:JJ Cauae(l)Jmanner slaled.
o CORONER
. On Ihe belli 01 exemlnetlon and/or lrwelllodllQ(l, In my o~lo~alh occurred allhe lime. dare. and piece. and due 10 Il'1e causels}
and IMnntlr.laIBd. ~~ ' ~Lí'
S~n'lu" end Till. of Ceri/ß., Þ, I -X ..I . ,
31 A ADD ESS,ANDZIP OO-ë1 FIEÃ(TypeorprlnIJ-~" --.----...-----,----- .-. -.-.---...-
CltyfTown or County
Zip Code
/0 -t~"')::( '-<
39c. DATE SIGNED
C-~/:!::l.J~
MM DD YVVV
Christian T. Shull
4 I,
83404
.<tOb. DATE SiGNED
--.-'-,-
MM DD YVVY
m.~02Ž2a'!L
MM 00 YVVV
This Is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS,
DATE ISSUED:~'£¿ji '/+1 '2fJtT7
This copy not valtd unless prepared on engraved border.
displaying state seal and signature D'f the Registrar.
\.~. .
~;4~
JANE S, SMITH
STATE REGISTRAR
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