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RECEIVED 9/25/2008 at 10:30 AM
RECEIVING # 942452
BOOK: 705 PAGE: 571
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
BOOK
PR PAGE
COû571.
AFFIDAVIT OF SURVIVORSHIP
STATE OF WYOMING
)
)SS.
)
COUNTY OF LINCOLN
GAYLE IZATT, being first duly sworn upon her oath, deposes and states as
follows:
1. On the 11th day of November 2007, my husband, Keith C. Izatt, died as is
evidenced by the official certificate of death attached hereto and incorporated herein by
this reference.
2. At the time of his death he jointly owned an interest in certain real property with
me, said real property being located in the County of Lincoln, State of Wyoming, and
more particularly described as follows:
The South Half of the Southeast Quarter of Section 34, in Township 35 North,
Range 119 West, of the 6th Principal Meridian, containing 80 acres, more of less,
according to Government Survey. EXCEPTING, however, 1.51 acres heretofore
conveyed to Lincoln County by deed recorded in Book 2 of Quit Claim Deeds, at
Page 629. Subject to reservations in United States and State patents and to the
rights of the public in all highways.
, ...,
3. Said real property interest was originally conveyed to Keith C. Izatt and Gayle
Izatt, husband and wife as tenants by the entireties, with right of survivorship, by a
Warranty Deed dated 15th day of January 1962, and recorded the 17th day of September
1965, in the office of the Lincoln County Clerk and Ex-Officio Register of Deeds in
Book 71 ofP.R., Page 256.
'.)
4. By reason of my husband's death, I am entitled to sole ownership of the interest
in and to the above-mentioned real property.
Dated this & day of September, 2008.
STATE OF WYOMING )
)SS.
COUNTY OF LINCOLN )
Û'005·72
--hCfi~ ~
GAYL IZATT
The foregoing instrument was subscribed and sworn to before me by
Gayle Izatt this ~ day of September, 2008.
WITNESS my hand and official seal.
No~;¿t~:f~{V
JENNIFER BRYANT
NOfarv Public
Lincoln Cot.r1Iy
, Wyoming
t.4v COmmllllÓn Expires
My commission expires:
~
10
DÈpÄìhMÊÑT OF HElktH'
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Decedent:·· .
Name:
Gender:- ...
Date of Birth:
D.EA TH' CERTIFICATE
\'ta~e~ileN u~Jer: 2ð07~063~~5···.'
Keith C. Izatt
·:Mí3le.... .... ..'.::.: ,:,:' .....'.,
µanuà& 23, 1~27'
...S·ociaISecuriìy Number: ._
¡5ge at~~:,T¡Q1~of peath;'80 ye~rs
yOÚrtYôfllþè~th: U@cdln....
.....
.., Dat.e andplacQotDeath: . ........, .....
Date of !4eath: } NoVember 11,2007
City of Death: .c.c: Freedom'>. ..
..Additional Decedent Inf()rmation: "'.':
~Iace qf Birt~: ,/ Turnej;ville, \lVýorTiing
Residehce:Freedbm,Wyömiri~' .'
Marital Status: Married. NameofSuryivingSpouse:EmiJyGayle e:r.i<:;ksºn
...' NarneofFåthe~:... Lès.lielzatf<t\t:\)·· .'. .,..... '...'.. .....", .,.... ....., .' ...", ...,. ....... ..... ..... .... :.'
Maiden Nanie of Mbthèr:DeIií3ElìzaDethtrouèh
Informant: Wade K. Izatt ... ,
ibisposition:.··i "C>
..Method of Disposition:
Place of Disposition:
Manner of Death: Natural Death
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Certifier:
Name:
Address;
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..Oate Filed: