HomeMy WebLinkAbout939582
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STATE OF eJJ Y o)l)~,þ )
COUNTY OF I-I()í ,sPÆ/NJ
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(Ov536
AFFIDAVIT TERMINATING ESTATE
I, Annette M. Juvan, bemg of ]awful age and first duly sworn according to law,
upon my oath, depose and state:
1. That I am of adolt age, a resident of 4/( t7 /n1 (:!:1
Affiant herem.
. and the
2. That by virtue of the conveyance which is recorded in the office of the
County Clerk for LlncoJn County, Wyoming, located at Kemmerer,
Wyoming in Book 326PR on page 405 is rec:orded a Warranty Deed. The
Warranty Deed, dated the 23 day of March, 1993 conveys unto Gary J.
Jovan and Annette M. Juvan, Husband and Wife as Tenants by the
Entireties with fnll rights of survivorship the following described
property, to-wit:
Lot 17 Block Z of Lincoln Heights 4th S ubdlvJsiou, Lincoln County, Wyoming as
described on the omclal plat filed on October 3, 1977 as lustrument No. 499086
of the records of the Lincoln County Clerk
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3. That said Gary J. Juvan on the ~ I!? day of
,/fII,7uu¿....,.... t ~- . .J.fI'r/7 . and a copy of the original
éertificate of death, certified to as true an correct by public authority in
which the original of said certificate is a matter of rec:ord, is attached
hereto as Exhibit «A".
4. That by reason of death of said Gary J. Juvan by reason of 2-9-102 W.S.
(1980), the decedents btterest and title in said conveyance has terminated
and title to the real property conveyed thereby has vested absolutely in
Annette M. Juvan continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
Dated. /I.r} A;/ :l v".. ..2ø~ ~
"Cl~~>~~/
Annette M, Juvan
State of /.0Yo,"ilr.J6)
)55.
County of 1M SPIe..f,JØ~
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The foregoing instnunent was subscribed and sworn to me by Anne*t~:M-: l"::' ,.;, _
Juvan this 00 day of ~! ~"1 .2008 ;;' i'\' \ : ~;,,:: c' (
mmea my hand aDd ofðdù -;;:{'t_fH:~ ~
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My Commission Expires:
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otary Pub ..
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RECEIVED 6/6/2008 at 4:11 PM
RECEIVING # 939582
BOOK: 696 PAGE: 536
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
DECEDENT INFORMATION
Date of Death: -_ November 20, 2007
City of Death: Salt Lake City
Age: 54
Place of Birth: Kemmerer, Wyoming
Armed Services: No
SpolÌse's Name: Annette Arthur
Industry/Business: P & M Mine
Residence: Kemmerer, Wyoming
Mother's Name: Antonia Marchek
Facility or Address: St.,Mark's Hospital
CERTIFICATE OF DEATH
State File Number: 2007012835
I
Gary James Juvan
I
.........
Time of Death:
County of Death:
Date of Birth: j
Sex: ~/
Marital s(atus:
Usual Occupation:
Education:
Father's Name:
Facility Type:
22:47
Salt Lake
September 12, 1953
Male \
Married
Blaster
High School or GED
Charles William Juvan
Hospital ER
\
INFORMANT INFORMATION ,...".. i . ..".,., .:,< ,.' .....,,
Name: , . \ Annette Juvanq,.':'¡, ...'., , ",., ,.. ..,.,: RelatiqnshÎp:.
Mailing Address: 1505 Antelo~~ Stre,~t, Kemlllerer, vyyoming, 8~1 01
, ,
........
DISPOSITION INFORMATION.y",'·.r:.·... '.,> .,........... '..,'......' .,., '...'..) \
Method of Disposition: CrematiÓò" It,.......' (' '.'.,,'. ' ,.,,,¡,,,,..oate,ofDisposifion: Novembèr if;'2007
Place of Disposition: Utah,F.Uner,aVDJrector's Cremation Center, South tJoi'dan, Utah ' ';;;.~i":'
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FUNERAL HOIVIE INFORMA TIONß . ".."j:;' . " > 'r"." .." ,'j, 'ii'.,,,,:'"
Funeral Home: J~l1kins-Sdff~,,90uth¥alley.'.;/ , ' .'" .".,'
Address: 1 007 West South JordiulPark'-Vay, S9utt1:J()r<:l~n,U!ah
Funeral Director: 8,randon"J Gpulding c.' /.' . i'·, ',!";'<"':'
.,MEDICAL CERTIFICATIOt,i", ; ,,;;"3' .y.,
Certifying Physician: <3reg()ry Dupont MD, 3336. South 4155
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CAUSE.:O.F"DEATH ,:"'," ;;;":-, .,~ ~',,::,
, PneumOnia [Onset: 3. DaYŠÌ; ,I,,, ,...
! COPD[Onset:15 Years]':;;':;" ,"',.,.,,>.
, Tobacco,Use: " P~obablyColÌt~ibuted ,> ··,,):i.,
Medical Examiner contacte~,;';:~ ri~i9,8WIÌ;::,Autopsy ,p:,~If~rf'1e(?:'~0'=
December 4, 2007
This is an exact reproduction of the document',reglstered In the State 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
docum.,ntdlsplays the date, seal and signature of the State Registrar and the County/DistrIct Health Offlc¡er.
\
*061573422* &.:~
Director/Health Officer
County(Distrlct Hea!th Department
~ê~
Barry E. Nangle, State Registrar
Office of Vital Statistics
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