HomeMy WebLinkAbout939841
6010816675
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STATE OF ~':J f)\...4,:J ~
COUNTY OF L;C'cl¿'L..-- )
RECEIVED 6/17/2008 at 1 :34 PM
RECEIVING # 939841
BOOK: 697 PAGE: 439
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
88.
AFFIDAVIT TERMINATING ESTATE
I, ~ Q iI\'l f' b (Y 11/8 K~ . being of lawful age and first duly sworn
according to law, upon my oath, epose and state:
1. That! am ofadult age, a resident of KOnme,re,v¡ ÚJY . and the
Affiant herein.
Û00439
2. That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 165 PR on page 387 is recorded a
Warranty Deed. The Warranty Deed, dated the 9th day of
May . 1980 conveys unto
James E. and Karen G. Tynsky . Husband and Wife as Tenants by
the Entireties with full rights of survivorship the following described
property, to-wit:
See attached Exhibit "A"
3. That said Karen G. Tynsky died on the 5th day of
April , 1998. and a copy of the original
certificate of death, certified to as true an correct by public authority in
which the original.J.f said certificate is a matter of record, is 'attached
hereto as Exhibit 'WI.
4. That by reason of death of said natural causes by reason of
2-9-:102 W.S. (1980), the decedents interest and title in said conveyance
has terminated ~nd titlet~ the real:prope~ cq.qvey:~d thereby has vested
absolutely in James:~E~ - r}í'nsk~'~ as 'l:1trnin'ít~if since the death
, of thr said decedent.
FVRTHERAFFIANT SAYETH NOT.
Dated G ~ 10" d' J
r r:. ~?.ß)
State of Wý01'hiW)
County of LI n ( )Jh
)
)ss.
)
J ':Ç.h.!t:: foreg~ing instrument was subscriþed and sworn to me by
4M ~;1YII.5K.'i this J 1)-t.!J day of !..Jµ i'\R aC:J08
Witness my hand and official seaL
My Commission Expires:
~~~
)O--jq '-dO) ,
Stacy
Exhibit A
File 6010816675 Description
000440
The land referred to in this document is situated in the State of Wyoming, County of Lincoln, and is
described as follows:
Lot 1 And 2 in Block 8 ofthe Willow Addition, to the Town of Kemmerer, Lincoln County,
Wyoming as described on the official plat thereof.
(;'0044
CITY OF FORT WORTH, TE~S ,
VITAL STATISTICS DIVISION ,$hen,by oertrfy that this Is II
copy df1he original document.
STATE OF TEXAS
CERTIFICATE OF DEATH
1. NAME OF DECEASED (a) FIRST
(b) MIDDLE
(c) LAST
(d) MAIDEN
VI
C)
:z¡ 4, DATE OF BIRTH
:¡::
S Oct. 27,
en 8, RACE
¡¡¡
...
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Q)
...
Æ 201 Beryl Street
I 15e, COUNTY
.c
-=
m 16, FATHER'S NAME
:z:
KAREN
White
12, MARITAL STATUS
ŒI MARRIED B NEVER MARRIED
o WIDOWED DIVORCED
,15a, RESIDENCE STREET ADDRESS
James E. Tynsk
15e, ZIP CODE
Kemmerer
151. INSIDE CITY LIMITS
Lincoln
15d, STATE
Wyoming
83101
KJ YEs,
oNO
Marion G. Sisemore
Marguerite McAtee
18, PLACE OF DEATH CHECK ONLY ONE
-
o
-
c
~ HOSPITAL: 0 INPATIENT 0 EfVOUTPATIENT 0 DOA OTHER: 0 NURSING HOME QJ RESIDENCE 0 OTHER (SPECIFY)
1:: 19, COUNTY OF DEATH 20, CITY OR TOWN (IF OUTSIDE CITY LIMITS, GIVE PRECINCT NO,) 21, NAME OF HOSPITAL OR INSTITUTION (II nolln Inslilulion. show slreel address)
III
Do
Q)
C 22, INFORMANT - SIGNATURE & RELATIONSHIP
VI
~ James E. T nsk
(!!. 24, METHOD OF DISPOSITION
Tarrant
Fort Worth
5408 Collinwood Avenue
23, MAILING ADDRESS OF ,INFORMANT, '
o BURIAL
o CREMATION
[]: REMOVAL FROM STATE'
o DONATION
o OTHER (SPECIFY)
St. Kemmerer WY83101
29, NAME & ADDRESS OF FUNERAL HOME
'ii: ....,u, '. ~
"":;1,':;<;'~"'~
Greenwood Funeral Home
3100 White Settlement Rd.
Fort Worth, Texas 76107
...t:.~..
.5
f!
to
~ 30. CERTIFIER
o~
;¡; m' MCERTlFYING PHYSICIAN
,8'"' Œ
I: g 0 MEDICAL EXAMINER }
~, ~ 0 JUSTICE OHHE PEACE
"III
.2 ai . SIGNATURE & OF CERTlFIE
.!! -g-tt.
=u
I: '
;:;- 34,PRINTEDNAM &ADDRESSOFCERTIFIE~""~ , ;;7 ' ,'ï" '"",' f: \
~~~ Robert Mennel M.D. ~<':,\~t":;3535;,Worth Suite 280';;i¡ ,J'iiá~l;~~¡/TXI 75246
~ ~ ~ 35, PART 1 ENTER THE DISEASES, INJURIËS'OR,COMPLlCATlÓNS}HAT CAUSED THE DEATH. DO NOr'ËNTERcTHE MO,R.EQ# DYING SUCH AS
~ : i CARDIAC OR RESPIRATORY ARÀ~S~;~,~OC~~R HEAitr.~~!,()~~:, ,~I~~"O.~,~;,~ë,I"J " ON EÃ~fi LI~~~)/ "
! ~ IMMEDIATE CAUSE (Final disease' ;""'--;~ v' , "'",, '.,' f '
III --: or condition resulting In dealh) ? a, , ' DUE TO (ÖI'tAS ALi.KEL Y CÓÌI!SEoueNcE olj):¡; r'
f i ~Sequenllally IIsl condlllons,lf any, { b, '^'~UE JO!:::~S A~~~LY~~~:Eáu~j~Jr~~::,J"
~ ~ ~ ~~~~~~;;:eg~~"s~a~:/:~~~~er c,"'<~""("<:,/::,i,,,J:,,Ljj:,,, ,
i¡': u. or Injury thallnltfBtad events DUE TO (OR AS A LIKELY CONSEQUENCE OF)::
j ~' ~resu/tlng In death) LAST
...2 ~ d,
.2.. ï:5 PART 2 OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING IN THE UNDERLYING 36a. AUTOPSY7
~ 'C CAUSE GIVEN IN PART 1 (1,0" subslancs ebuso, alebolss, smoldng, ole,)
I; /\/&-,J ~
t= c. 37, DID TOBACCO USE CONTRIBUTE TO DEATH
DYES o PROBABLY
NO 0 UNKNOWN
40, MANNER OF DEATH 41a, DATE OF INJURY
~TURAL
o ACCIDENT
U')
~ 0 SUICIDE
~ 0 HOMICIDE
W 0 PENDING INVESTIGATION
a:
C\I 0 COULD NOT BE DETERMINED
~', 42ÒR21~TRAR1E~f'8 6
33, TIME OF DEATH
11:46
A.
M.
Jab, AUTOPSY FINDINGS AVAILABLE
PRIOR TO COMPLETION OF CAUSE OF
DEAl:H7
38, DID ALCOHOL USE CONTRIBUTE TO DEATH
DYES 0 PROBABLY
N 0 UNKNOWN
41b, TIME OF INJURY 41e, INJURY AT WORK
DYES DlNO
39. WAS, DECEDENT PREGNANT
ATTlMÈOFDEATH DYES
WITHIN LAST 12MO DYES
41 d, PLACE OF INJURY - AT HOME. FA
ETC, (SPECIFY) ,
DYES
IX! NO
DUNK
DUNK
M, DYES
41e, LOCATION (STREET AND NUMBER, CITY OR TOWN, STATE)
ONO
411, DESCRIBE HOW INJURY OCCURRED
42b, DATE RECEIVED BY LOCAL REGISTRAR
APR
~OWR~
L F .. 0 S11' (·10
This is to certify that this is a true and correct reproduction of the original record as recorded in this office. Issued
under authority of Sec. 191.051, Health and Safety Code. : V ' "
t:7)~ ~ Ø-ad~
ISSUED APR 111998
LOIS H, WALLACE
ACTING LOCAL REGISTRAR'
WARNING: IT IS ILLEGAL TO DUPLICATE THIS COPY.
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