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AFFIDAVIT OF SURVIVORSHIP
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I, CAROLYN HULTQUIST, being of lawful age and being first duly sworn according to
law, upon my oath, state as follows:
1. That LARRY EDWIN HULTQUIST died in the County of Lincoln, State of Wyoming on
the 2rd day of April, 2008. See attached copy ofthe official Certificate of Death, issued
by the State of Wyoming, Department of Health.
2. That on the 3rd day of October, 2002, LARRY E. HULTQUIST AND CAROLYN F.
HULTQUIST purchased the following described real property from FEDERAL HOME
LOAN MORTGAGE CORPORATION:
Lots 3 and 4 of Block 51 of the Second Addition to the Town of
Kemmerer, Lincoln County, Wyoming, as the same is laid down,
platted and described of record in the office of the County Clerk
and Ex-Officio Register of Deeds in and for Lincoln County,
Wyoming, together with all improvements thereon situate.
3. That FEDERAL HOME LOAN MORTGAGE CORPORATION, duly and regularly
executed and delivered a Warranty Deed dated October 3,2002, in favor of LARRY E.
HULTQUIST AND CAROLYN F. HULTQUIST, husband and wife as Tenants by the
Entireties, and that they owned and held title to said real property as Tenants by the
Entireties, continuously from said date until the death of LARRY E. HULTQUIST on
April 2nd, 2008. Said Deed was recorded October 11 t\ 2002 in Book 501, at Page 608,
with the Lincoln County Clerk, in Kemmerer, Wyoming.
4. That CAROL YN HULTQUIST survived said LARRY E. HULTQUIST, and by virtue of
said tenancy by entirities vested in her upon the death of LARRY E. HULTQUIST, and
that CAROL YN HULTQUIST became the owner in fee simple of all the real property
described above. .
5. That this affidavit is made in accordance with the provisions of Wyoming Statute Section
2-9-102.
FURTHER AFFIANT SA YETH NAUGHT.
DATED this -Æ- day of YJt.~
RECEIVED 5/22/2008 at 2:03 PM
RECEIVING # 939206
BOOK: 695 PAGE: 230
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
, 2008.
~HÙ="£é
STATE OF WYOMING
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COUNTY OF LINCOLN
The foregoing instrument was sworn and subscribed to before me by CAROL YN
HULTQUIST on this -Z .2- day of rYìrlj , 2008.
Witness my hand and official seal.
(~l~'\vy\D.--(=:) - t1(ò-~L
Notary Public
My Commission Expires:
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oAVAf'!iI!A L. flAW (f:S - NOTARY pUßLÍc: _1
. COUNlY OF STATE OF
LINCOLN IWOMING
My conm;:.~~!~~~:l!zJ~ 11_..
'stATE" OF:WY'OlvllNGH
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Decedent:' /.
Name: Larry Edwin Hultquist
H' Gender:H. HHMal~
: Date pf Bir1h::iMay~.4y 194t
/ Date and Place of Death: '
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Location: Decedent's'home.·:"'" .......
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Residence: .. Kemmerer, Wyoming ';,.f·. .
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Name of Father: .Caryl J. Hultquist.
.... Maideny.Name of Mother: Irene A,ft" Carlson ,¡.,.......~.;.
,Infor~árît:.·./':.Carðlýn F. fjultq~..i~~·., . "T .,~:.,",.
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Mét~ôddf-oiSPOSitiÖO': Removal from State' .,' .:'. ';:;".' I"~ .
¡Plâce ofPiS..Pq~iti?n:./ U..F.D~ crematio~,~e~t~r, South Jo~dan" UT-
I FuneraJ Home or., F.acility:.. ' , . .: . . ,,' . . .
Facility: . .... Ban Family Chapel; Kliimmerer, Wyoming:
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. ,Date Filed:. '"H!\pri/08,2QPS..
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