HomeMy WebLinkAbout939847
RECEIVED 6/17/2008 at -, .. . ...
RECEIVING # 939847
BOOK: 697 PAGE: 475
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
000475
AFFIDAVIT REGARDING TERMINATION OF LIFE ESTATE
OF LANE F. LAKER
WE, LOYD F. LAKER, of Blackfoot, Idaho, DARLA MAE NELSON, of Grover,
Wyoming, LOA JUNE NIELD, of Afton, Wyoming, and VIRGINIA SHUMWAY, of
Freedom, Wyoming, as tenants in common, being duly sworn under oath, state as follows:
1. That we, along with Lane F. Laker, deceased, have a life estate in certain
real property in Lincoln County, Wyoming, said property being more particularly
described as follows:
Beginning at a point which is 200 feet South from the Southwest Comer
of the SEl/4NEl/4 of Section 27, Township 35 North, Range 119 West, ofthe 6th
P.M., and running thence South 17 rods, thence East 17 rods, thence North 17
rods, thence West 17 rods to the point of beginning. Said tract to include said
home, improvements, and other outbuildings.
A copy of the Quitclaim Deed by which said life estate was reserved, which was
recorded in the Lincoln County, Wyoming, land records in Book 573 PR at Pages 85 and
86 on November 19,2004 as Receiving No. 904704 is attached hereto and is incorporated
herein by reference.
2. That Lane F. Laker died in Idaho Falls, Idaho on May 10,2005. A copy
of the Certificate of Death that issued for Lane F. Laker is attached hereto and is
incorporated herein by reference.
3. That the death of Lane F. Laker has terminated his life estate in the
property identified herein.
4. That this Affidavit Regarding Termination of Life Estate is submitted
pursuant to Wyoming Statutes § 34-11-10l.
WITNESS OUR HANDS this J2~ day of June, 2008.
[Separate signature pages follow.]
AFFIDAVIT REGARDING TERMINATION OF LIFE ESTATE
OF LANE F. LAKER
PAGE 1 OF5
'1 ,;
000476
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STATE OF IDAHO )
) SS.
COUNTY OF BINGHAM )
SUBSCRIBED, SWORN TO, AND ACKNOWLEDGED before me on this, the 9 tr-
day of June, 2008, by Loyd F. Laker.
WITNESS my hand and official seal.
(/iÍ/p¡-¿t£ûrJI
NOTAR PUBLIC
My Commission expires: J~ II,P/:?
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AFFIDAVIT REGARDING TERMINATION OF LIFE ESTATE
OF LANE F. LAKER
PAGE 2 OF5
è00477
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(47iL~·~
DARLA MAE NELSON
STATE OF WYOMING )
) SS.
COUNTY OF LINCOLN )
SUBSCRIBED, SWORN TO, AND ACKNOWLEDGED before me on this, the -.M....
day of June, 2008, by DarIa Mae Nelson.
WITNESS my hand and official seal.
NOTARY PUBLIC
~UÞ.NN EPPLER STATE OF
COUNTY OF wYOMING
LINCOLN I\RC\125,2011
»'5S\ON £XI'IRF.5 M
M'I CO\lil"~""""",
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My Commission expires: ~
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TA YPUBLI
AFFIDAVIT REGARDING TERMINATION OF LIFE ESTATE
OF LANE F. LAKER
PAGE 3 OF 5
000478
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STATE OF WYOMING )
) SS.
COUNTY OF LINCOLN )
SUBSCRIBED, SWORN TO, AND ACKNOWLEDGED before me on this, the ¡{Jilt
day of June, 2008, by Loa June Neild.
WITNESS my hand and official seal.
County of
Lincoln
State 01
Wyoming
..~
GERALD L. GOULDING· NOTARY PUBLIC
My Commission Expires May 2, 20 1
My ommlSSlOn expIres:
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AFFIDAVIT REGARDING TERMINATION OF LIFE ESTATE
OF LANE F. LAKER
PAGE 4 OF 5
û00479
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V~NIA SHUMWAY 1-
STATE OF WYOMING )
) SS,
COUNTY OF LINCOLN )
SUBSCRIBED, SWORN TO, AND ACKNOWLEDGED before me on this, the ,~
day of June, 2008, by Virginia Shumway.
WITNESS my hand and official seal.
M. KEVIN VOYLES - NOTARY PUBLIC
"
COUNTY OF STATE OF
LINCOLN WYOMING
MY COMMISSION EXPIRES JULY '16, 2011
My Commission expires: Ô7!J, III
I (
AFFIDAVIT REGARDING TERMINATION OF LIFE ESTATE
OF LANE F. LAKER
PAGE50F5
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STATE OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
DATE FILED BY STATE REGISTRAR:
Slale of Idaho
CERTIFICATE OF DEATH
STATE FilE NO.
2!L5.i:Þ7
OU.."" COf"!' 01" THIS DOC~,". Cf.,""I£D "., '141 ""'I! II(IIIS'''''''WI'" TMf. "".....'MI!H' Of- ""lTM NIO'M!tlAIIII!
llAI.n UAL IW\U (If. unO'''. pmu,a. F'-1;1I1V'IO(JC1! 01' THIS MA114~1I, pl-2UPOIANÞ .,..116.10...." Coni!
* 1. DECEDENT'S LEGAL NAME (Indude AKA's If any) (Flrsl. Middle. Last, SumJl
3. SOCIAL SECURITY NUMBER
8, 1955
_ Wyoming Tha ne
~ 7d.STAEET DNUMBER fe. APT. NO. 11. ZIP caDE 111. INSIDE CITY
~ 268 Lost Creek Road 83127 ~~;:? ¡I No
Ž ~ II. MARITAL STATUS AT TIME 0 DEATH ..- ----------·-·--·-·--r:-SURvtVIÑÕ· sPOUšFšÑÄMEiiiWife. glVë'rnølden nerne)
~ ~ 0 M.rrted 0 Married. 001 Stparaled 0 WIdowed at Divorced £.l Never married U Unknown
~ œ ,., :~E,M~~ U.S. 111. FATHER'ŠÑÃMÊ1FIj.";¡"Mii1dië.TãSi:l;UìfrXl--, -,',-..---------- -.--.-..--. ---- -f11b:"êlRTHPL',ÃC,E ISlile:1tirtiíõfV,:õrFôfëiõñC"oon¡¡:Ÿ¡-..
o -g FORCES? Frank J. Lak,~,~_____,_,_________ _1:!.:Œ!!',ing
:E ; 0 VIs 12._ MOTHER'S MAIDEN NAME (First Middle. La51. Sum,,) 12b. BIRTHPLACE ISI8Ie. Tl!rrllOf)', or Foreign ttovnlry) _
'~Ql:No Grace Virginia Petersen Idaho
¡ Ua.INFORMAHrs NAME (Type or pnnl) ]:Jb' RËLÃrióÑSHIP TõDËëËÕËÑT 13c-:MAitiÑGÃÕORESS(Slreei8nd N~~, Cily.Siiíê, Zip Coder--
ã Vi i i Sh P . O. Box 197 '
, E ~ n a umHay sister Freedom, Wyoming 83120 ___
8 ... 104. METHOD OF DISPOSITION 15. PLACE OF DISPOSITION (Name and address or cemelefY. * 11. NAME AND ~ ADDRESS OF P;UNERAL FAC~
'RBuri.1 OCrelT1Ðllon crlamalory,mherplaceJ Schwab r10rtuary
g::.:::.rom....;.,DEnt.....,menl Freedom Cemetery 44 East Fourth Avenue
o O'herIS..d Freedom, Idaho Afton, Wyoming 83110
* 17.. BIG E L EE OR PERSON ACTING AS SUCH * 17b. LICENSE NUMBER (Of lie en. see) 11. WAS CORONER CONTACTED?
M - '676 0 vo. ]!I No
PLACE OF DEATH (19.23L....-
* '''.IF DEATH OCCURRED IN A HOSPITAL: 1* 19b. IF DEATH OCCURRED SOMEWHERE OTHER THAN A HOSPITAL:
1m Inpellenl ,0 ER/Oulpal1enl ,0 DOA '10 HospIce fadllly .0 NurslnghomeJlong lerm c.øre '.dUly .0 Oecedenl's home ,0 Other (SpedfYJ
* 20. FACILITY NAME (II Il2\ "dilly. give slreeland nutT1b@r) * 21. CITY, TOWN, OR LOCATION OF DEATH, AND iiPCõõ'E-- * 22. COUNTY OF DEATH
Eastern Idaho Regional
Medical Center
* 23. DATE OF DEATH (Mo/DayNr (Spell rmnlh
May 10, 2005
12''')
Idaho Falls 83404 Bonneville
25. DATE PRONOUNCED DEAD (MoIDøyNr) (Spell month' 21. TIME PRONOUNCED DEAD
1715
(2'h' May 10 2005
21, CAUSE OF DEATH
PART I. Enler the ~ n diseases. Injuries, or COR1'IIC8llons --lh81 dlreclly caused 1he dealh. DO NOT enle1" lermnal evenls such liS cerd'øc
.rresl, resplralory erresl. or ventricular librllll\lon wllhool mowing Ihe ellofogy. 00 NOT ADBREVIA TE. Enter only one c.øuse on a line:
He 0 c, ,Iv r-~~.J Sl~ 11 ct,- ht"-t'
OUE ~ I.. .. '"''"'w''''''' /rv .¡,'
<)1'11",11 ßc-w-J' O¿.s c ~
I ApprolClmøle InteMlI:
I OnsellO (Julh
t
i2 Lu.........
13/r.Æ1..n
Ye.W5
Yc-4 "'5
IMMEDIATE CAUSE (Final
dlse"e or condtllon -+ a.
r8!lulllno In deelh)
Sequenlløny Ilsl condlllons. b.
nany, leødlng 10 Ihe cøus. D~O of/'lœn.I!It"MCeL' ,
Usled on line e. Enter the -Þ11o.H:"T Il.,J ( ~
~ t'.:i~;:':~: ~AI~J:' QUE TO lor.. _ tonl8lfUl!IICII 01):
~ ::~~:~d~r::h)enls d. (' ; r, tun-< -$~
o PART n. Enler olher slanlncanl condlUons conlribullno 10 death.bul nol resulllng In Ihe underlying cause given In Pari I
[it! '
~ î '" k (~" I L; -rA-f' fr,: (J.-C,
u. f\I n. DtD TOBACCO USE 3D. IF FEMALE (Aged 10·541:
¡::: ~ CONTRIBUTE TO DEATH? 0 Nol pregnant wllhln pasl year
ffi ~ 0' Ya. 0 Probably 0 Pregnant al lime 01 dealh
u:f \..t .. 0 Nol pfegnanl. bul pregnøn!
IJ ~o 0 Unknown withIn 42 days of deølh
-i 32. DATE OF INJURY (MoIOayfVr) 33. TIME OF INJURY
ð (SpeW mon!hJ ' -
31. lOCATION OF INJURY: Slate
U Nol pregnanl. but pregnant 43 days
to 1 year before dealh
D Unknown I( pregnanl wUhln Ihe pasl
year
2I.:WAS AN AUTOPSY ;2Ib. WERE AUTOPSY FINDINGS
PERFORMED? I ~VAIl.A8lE TO COMPLETE
. I THE CAUSE OF DEATH?
DVes ~o ~ i]Yes ~
31. MANNER OF PEATH
~NalUføl 0 HOfridr'le
o Accident 0 Pendinv Invesllgallon
o SuIcide. 0 Could nol be delermned
35. INJURY AT WORK?
3". PLACE OF INJURY (Oeceden!'s horrw!. førm. slreel, con.lruetlon IlIe.
nursIng home, real.want. loresl. elc.)
() VIII'
o No
(24hr
lip Coda
CllyrTown or County
Slreellnd Nurrblllr or Locallon Aparlmml Ntlniter
. DESCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY, STATE THE TYPE(S) OF VEHIClE(SIINVOLVED (Automobile. pickup, molorcycle, TV. bicycle. elc.)
SPECIFY,WHICH VEHtClE DECEDENT OCCUPIED. If applicable
TRANSPORTATION j31.. WAS DECEDENT: 0 OrlverJOperator 0 Pasltlnger l38b. WHAT SAFETY DEVICE!S) 010 DECEDENT USE/EMPLOY?
INJURY ONLY I 0 Pedesl"an 0 Olher S eof ) I 0 Seal bell 0 Child !Ulrely seal 0 Helmel 0 Air bag 0 None 0 Unknown
3". CERTIFIER (Check only one, blled on omdal tepadly 'or Ihls cer1lßcale) 31b. C N NU BE
". R PHYSICIAN - To Ihe best of my knowledge. dealh occurred allhe time. dale, and pllce, and due 10 the a.tUlrJ1cøus.ls)lfTl8nner .Ialed. - .7 'Ó2. C!J
. 0 CORONE"· On Ihe basis of eltarrinøllon and/or Inv8sllgallon, In my opinion, dealh::qU"..d he lime, dille, ,nd place. and due 10 Ihe 3Ic. DATE SIGNED ....
C8use(s) and manner staled. /J ~ t? . ~,./I , zooS-
Slgnatur..ndTlUllorCertlner" ~' . " M co-vm-
* 3Id. NAME. ADDRESS, AND ZIP CODe OF CERTIFIER (Type or prlnl)
Clint E. Behrend, N.D. j 2770 Cortez Avenue; Idaho Fails, Idaho 83404
40.. CORONER'S SUBSEQUENT SIGNATURE IF NECESSARY: The coroner's slgn.lure In Ihl.llem ,upersedeslhal of Ihe physldan. ,cOb. DATE SIGNED
IInd 1I1e corooer become. Ihe cer1mer or record.
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This is a true and correct reproduction of the document officially registered and placed
on file with Ihe IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS,
DATEISSUED:~ \ 'S) '~00S;
This copy not valid unless prepared on engraved border
displaying state seal and signature of the Registrar,
~7~
JANE S. SMITH
STATE REGISTRAR
QUIT CLAIM DEED
'~'I. 0085
KNOW ALL MEN BYTIÙ:SE PRESENTS; that VIRGINIA SHUMWAY of Freedom,
Wyoming, LOYD R LAKER ofBlackfoot. Idl1ho, DARLA MAE NELSON of Grover, Wyoming, LOA JUNE
000481.
NIELD, of Afton, Wyoming, and LANE F. LAKER of Thayne, Wyoming, grantors of, Lincoln County,
Wyoming, for and in consideration ofTEN DOLLARS ($10.00) and other valuable consideration, ill hand
paid, receipt of which is hereby aèlmowledged, have hereby remised; released and forever quit claimed' unto
the said VIRGINIA SHUMWAY of Frecllom, Wyoming, LOYD F. LAKER of Blackfoot, Idaho, DARLA
MAE NELSON of Grover, Wyoming, amll..OA JUNE NIELD, of Afton, Wyoming, as tenants in common,
grantees, thcir heirs and assigns forever, all slIch right, title, interest, property, possession, claim mid demmld,
as they may have or ought to have, in or to alllhe followiug described property, hereby releasing mId waiving
an rights uncler and by virtue of the homeslcad exemption laws of the State of Wyoming;, to-wit:
The East half ofthe Southeast Quarter and the Southeast Quarter of the Northeast
Quarter of . Section Twenty Seven in Township Thirty·Five, North of Range 119
West oftbe 6d' Principal Meridian, \V)'01111ng. Reserving however unto Grantor
a Life Estate ill the following described property: Beginning at a point which is
200 feet South from the Southwest ('orner of the SE 1/4 NE 1/4 of said Section
27, Township 35 NorUl, Range 119 East ofthe 6'" P.M. and ruuning thence South
17 rods, thence East 17 !'Ods, thence North 17 rods, thence West 17 rods to the
point of beginning.
LESS THAN: Beginning at a Point in the South line of said SE1I4 SEl/4, being
, the Cotton Gìn Spike marking the South corner of the SmIders property referred to in
the Deed recorded in Book 442PR, un Page 248, of said record, said point being 208.71
feet S89118'55"E, along said South line, from Cotton Gin Spike marking the Lloyd B.
Baker PE/LS 698 2000, location for the Southwest Corner of said SE1I4 SEl/4; thence
NO'43'19"E, along the East line of said Sanders propcrty, 323.81 feet: thence S86'29'20"8
424.57 feet; thence SO'34'19"W 302.117 feet to a point in said South line; thence
N89'18'55"W, along said South linc, 424.8'5 feet, to the Point ofBegil111ing, containing
3.053 Acres of land.
-SUBJECT TO: A 33·feet wide Rjg.ht-of~ Way Easemcnt, along the South line of the
above described property, being Wyoming State Highway 239.
TOGETHER with all improvemenls and appurtenances thereon. Subject, however, to all
reservations, restrictions, exceptions. casements and rights..:9f.~way,o{Jeç(mt ..,
RECEIVED 11119/2004 a111;21 AM
RECEIVING # 904704
BOOK: 573 PAGE: 85-86
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER
Lrrk~r Deed Page J of 2
'. ...........t. .....~~,..'""'....,.. "~~_'.
û00482
. .,~....,~.:......:.. .......... .;... .~. ........ .....·,.,..·.,t·~.".- ..~...;...... .
WITNESS my han,d this 171h day of November, 2004. I l"~ 0 G 8 6
//" . IJ: ~ ' ,
..4;..;'" ,41, t1 il A./1:'t0-ltÁ -
v'7. WAY . .... -#
?5v¿Æ
LQYD F. LA ER
,
é:i~ '-ft,µYz.lLJJ~
PARtA MAE NELSON
'£i2
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C'>:i-:it. a¡;/ðI"£'. r-:Q ,
-t.OA JUNE NIELD '
THE STATE OF WYOMING)
) SS. '
COUNTY OF LINCOLN )
, ~~
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LANE F. LAKB;:J- .. .. .
, The foregoing instrument was acknowledged before me by VIRGINIA SHUMW A Y, LOYD F.
LAKER, DARLA MAE NELSON, LOA.rUNE NIELD, and LANE F. LAKER this] 71h day of November,
2004.
Witness my hand and official seal.
,
CHRISTINA K. ALLRED· NOTARY PUBUC
CountY 01 .<t~ 81ale,ol
Lincoln' ~ Wyoming
t My Commission Expires 4/3012005
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{' [l/LicJ~wJ J{ ~
NOTARY PUBLIC
My Commission Expires: 4· :?fJ-f)...<J
Laker Deed. Page 11~r 1