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RECEIVED 7/21/2008 at 11 :55 AM
RECEIVING # 940681
BOOK: 700 PAGE: 414
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
STATE OF WYOMING )
) SS.
COUNTY OF LINCOLN )
00C:414
I, JEROME P. ANDERSON, being duly sworn under oath, state as follows:
1. Laverne E. Anderson had tenancy by the entireties with me in land in Lincoln
County, Wyoming, more particularly described as follows:
Lot 34 in Prater Canyon Estates, Unit 4, as shown on the official plat thereof filed
in the official records of Lincoln County, Wyoming, on July 6, 1970, as Instrument No.
423838.
Attached hereto is a copy of the Warranty Deed that created the tenancy by the entireties,
recorded in the Lincoln County, Wyoming, land records in Book 465 PR at Page 173, on May
25,2001, as Instrument No. 873496.
2. I, Jerome P. Anderson, the surviving spouse of Laverne E. Anderson, hereby
certify that Laverne E. Anderson died on March 19,2008. Attached hereto is an original copy of
the Certificate of Death issued for Laverne E. Anderson.
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3. Pursuant to Wyoming Statutes § 2-9-102, I certify that the tenancy of Laverne E.
Anderson has been terminated by her death, and that title to the above-referenced land is now in
the name of Jerome P. Anderson, a single man.
DATED this I t¿ day of July, 2008.
ACKNOWLEI}GED, SUBSCRIBED AND SWORN TO before me by JEROME P.
ANDERSON this ./1:!!1 day of July, 2008.
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: 07 Ill. Iff
I ,
QUIT CLAIM DEED
C00415
JER01v:ΠP. ANDERSON, a single man, grantee of County of Lincoln, and State of
Wyoming, for and in consideration ofTEN DOLLARS ($10.00) and other valuable consideration, in hand
paid, receipt of which is hereby acknowledged, CONVEYS to JEROME P. ANDERSON and LAVERNE
E. ANDERSON, husband and wife, tenants by the entireties, grantees of County of Lincoln, State of
Wyoming, the following described real estate situate in County of Lincoln and State of Wyoming, hereby
releasing and waiving all rights under and by virtue of the homestead exemption laws ofthe State, to-wit:
Land 34, Prater Canyon Estates, Unit 4, as shown by the official plat of s£d subdivision, filed July 6,
1970 as Filings No. 423838 in the Office of the County Clerk of Lincoln County, Wyoming.
Subject to reservations and restrictions contained in the United States Patent and to easements and
rights-of-way of record or in use.
Together with all improvements and appurtenances thereon.
WITNESS our hands this ~ day of May, 2001.
'BOOK- 465pR PAGE 1 7 3
REC -
LINCOLN CO
o \ t\A Y 2.5 Þ.\'\ 81 2 t
JEANNE WAGNER
KEMMERER. WYOMlteG
813496
STATE OF WYOMING )
) SS.
COUNTY OF LINCOLN )
..
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The foregoing instrument waS acknowledged before me by JEROME P. ANDERSON this
day of May, 2001.
WITNESS my hand and official seal.
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JEWEL R. SMITH· NOTARY PUBLIC
. County of State of
lIncoln . WyomIng
My CommissIon Expires May 18, 2004
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My Commission ExpIres: 5- I @.--O Y
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N T ARY PUBLIC