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RECEIVED 5/9/2008 at 11 :25 AM
RECEIVING # 938865
BOOK: 694 PAGE: 137
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
tJOO1.37
In The Matter Of The Estate Of:
Lea S. Carvalho,
Deceased.
AFFIDAVIT OF SURVIVORSHIP
PURSUANT TO WS § 2-9-102
STATE OF WYOMING
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County of Teton }
I, Gary J. Carvalho, being first duly sworn, do hereby state as follows:
1) I am an adult, competent to testify, and the surviving spouse to Lea S. Carvalho, also
sometimes referred to as "Lea Suzanne Carvalho";
2) I make the following affirmations based upon my own best investigation, information and
beliefs;
3) I am an interested person and make this Affidavit pursuant to WS § 2-9-102, as amended;
4) 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, (the
"Subject Property"):
Lot 195 ofthe Nordic Ranches, Division Number 13, Lincoln County, Wyoming,
as described on the official plat thereof.
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Together with but subject to that certain Grant of Access recorded in Book 472 at
Page! 703, as Instrument Number 875928, with the Lincoln County Clerk.
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Including and together with all improvements and appurtenances thereon and
ther~unto belonging, but subject to taxes, reservations, covenants, conditions,
restqçtions, rights-of-way and easements of sight and record, if any.
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5) The Subjectj Property was conveyed to Lea S. Carvalho and Gary J. Carvalho, as husband
and wife, vifl that certain Limited Liability Company Warranty Deed, dated September 8,
2005, and r~corded with the Lincoln County Clerk on September 9, 2005, in Book 597, at
Page 112, a~ Instrument Number 911690;
6) That Lea S.: Carvalho passed away on March 21, 2008, and the place of last residence of
Lea S. Carvalho was Lincoln County, Wyoming. See Attached Exhibit A: Death
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Certificate; I '
7) Following the death of Lea S. Carvalho, Gary J. Carvalho is the sole interest holder in the
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Subject Pro~erty and holds fee simple absolutê title to the same; and
8) Further Affiant sayeth naught.
Dated this APril;?S\f\ ,2008.
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~ ~/ß<-
ary J. Carvalho, Affiant
PO Box 8474
Jackson, Wyoming 83001
{Acknowledgment on Following Page}
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AFFIDAVIT OF SURVIVORSHIP PURSUANT TO WS § 2-9-102
Page - 1 of 2
STATE OF WYOMING
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~00138
COUNTY OF TETON
The foregoing Affidavit Of Survivorship Pursuant To WS § 2-9-102, was subscri~td,
sworn to and acknowledged before me by -Gary J. Carvalho, Affiant, on this April &ßV~,
2008.
Witness my hand and official seal.
[SEAL]
tary Public for the State 0fWY~ing
y Commission Expires: \ ~ \ . d{) LI
f"...................",."."..,..............._...........-
Dl:LLA LGBLANC - NOTARY PUBLIC
COUN1Y OF ëç:~ STATE OF
, TETON 4: WYOMiNG
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AFFIDAVIT OF SURVIVORSHIP PURSUANT TO WS § 2-9-102
P,age - 2 of 2
STATE\'OF WYOMING·"
DèpÄ~T~ï:NTOF tfEÄLTff\
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Decedent: ."
Name:
,Gender:, "
pate (:)f Birth:
IDEA TH CERTIFICATE
Lea Suzanne Carvalho
ð~~þ~r 15,\t96f?
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-\. StttteÞiléNJmher: 2008-Ó009S0
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Intêi'\täl: ..'..'.
. Not Rècorded
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"...,.'.. Soci~l$ecurit' N.Ul;:nbe.r: __ ..
~ge at.~h~ l[Im~ of Deatry: 41 y~ars
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Date and Place of Death: / .
DatebfÐeath:Mârch 21,"ZOQ8Actûát
Citýof Death: .... )Jaókson ...) .,
Location: Parents House
Additional Deèedeht Ihformåtión :(:
PlaceofBirth:·'·"{Missòula, Mðntaria,i
Residence: Etna, Wyoming
~r%il~ .~~~~~~j., -'~Örried..,...............·. ,.........'...'.......
Nr~e of Father:. John. Chapma.n. .' ......
. " Malden Nameof Mother: Jane Timmons
"Jnformðnt: ./' .'.',. "GarY.êarvåI1)6{' ..',
~~t~~~i~?Bfsposit om: Cremation .,....' , .
Plðçe ofpi$pq~itic?D;} VªlleYMÓft4ØtY..G[@matory;· Ja~l<~6n,\NYÞrriing
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." ". ""···.~~~Ii[y~I~}!J1~LO~5~C!~:~taií~YMørtÙ~rY¡J~Pk~pn, V¥ý~mi~g
pÒ~nty ofD~fith: 1;etÒIÍ
Cause of Death: .. . . .'. ¡ .
Thf] jmTrJediat~catJSeis Iistedorrthe.f¡fßt4¡ne,fúll0'vV~dbYåhy lliJde(JYifJg cal,{sès.
~g~~~~~~~i~I~~~:sr~~~~rH\HH}' ')( . .."'.' ",.. ,... ..' .,. ,', "
.....,ÔtherSigniryc~ntp~ndi~i~ns:~ot Recorde~..., .'..{\<. .....\ ,,'
..'·.Mannèrof be~:Ñatuf~1 De~tt'" "'.H'" ··,Tinie of death!07!31:Åótu~f
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Certifier:
Name: ,....,. "
Address: .
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M~rtha ·~J~a~L~.~;?\! .... '
555 EBROADWA Y,Jackson,Wyoming
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..,~Date ,Filed:
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'Marcþ31, 2908
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