HomeMy WebLinkAbout942898
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THE STATE OF WYOMING )
If U_ oJ""L \oJ, "''-'n· ,,~'--.I I
)55
THE COUNTY OF LINCOLN )
AFFIDA vrr
Caroline B. Kuehn, being of lawful age a.nd first duly sworn according to law, upon my oath,
depose and state:
¡. That Fredrick ¡. Kuehn, Sr. died onä-.~ 'í;2>.dn .,j ";11.,'.,«/. iT.
7 A Certificate of Title for a 1999 Brookfield Manufactured Home. VIN
1 DFLX04A22394BF13 was dul:¡ filed for record in the Office of the Lincofn Count}! Clerk on July
16, 1999, with owners as Fredrick j. Kuehn, Sr. and Caroline 8. Kuehn.
3. That by reason of the said title, Fredrick J. Kuehn, 5r. and Caroline B. Kuehn bt'!Glme
the owners of the property as joint ~enan~5 and title thereto vested in them continuously {rom said
date of filing, until the date of death of Fredrick }. Kuehn.. Sr. on /~ -.:) 5 -.1 r-:>n Q at which
time ~jtle to the above described properw vested abso/vrely in Caroline 8. Kuehn in accordance with
the provisions of §2-9-102, WS, (1980).
4. Affiant avers and certifies that deceased is the identical party named with Affiant in
the aforementioned title whose death terminated his interest, titre and estate in the said property;
and Affia.nt attaches hereto and makes a part of this Affidavit a copy of the official cel1.ificate oi
death of decedent, duly certified by the public authority in which said death certificate is a matter
of record.
Datedth 5~ of -~;¡P--1o.J
~'~4~L
roline B. Kuehn
, ,
State 01 Wru~ )1, ~./ -- -' - ,
Counry of _ ~~~
The foregoing instrument was subscribed and sworn to me bv Caro/me B. Kuehn chis 5 ~
day o{ ~n+U??&r ~8 ' -
, r
Witness my hand and official seal.
0¿"~bIiC
My Commission Expires;
3~ iô ~C>15
RECEIVED 10/15/2008 at 3:38 PM
RECEIVING # 942898
BOOK: 707 PAGE: 118
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
L.ISA TETLOFF
Notary Public, Saginaw County, MId1Igan
ActIn; In Seglnaw County
My Comrnieeb1 ExpII'II MII'WI1 0, 2015
c
69~9'oN
10J)G3 rUB a ¡!_ SJuel IV
V¡dt'~: :
r ~. '" ...
dUL<
, des
2000-2337
~
00&£:1;9
LF
STATE OF MICHIGAN
OEPAATIotENT OF COMMUNITY HEAlTH
STATE FILE NUMBER
TYP[¡PRINf
\J IN
Pt:RMANENT
t.. BLAC" 'N"
..
'q
....
~
~
"<
\)8
ª
!Z!
w~
Su
u-
~i
~:;
...~
23
~...
I'
CF
CERTIFICATE OF DEATH
1701626
iP?
4b. UND£R 1 "'EAR
MONTHS I OAV5
I
J DArE Of O[ATH'::(I\'øn'~.ß"y. Yt.(r.-.-:.-.-.
De'CEl'f4'e (j'Z~ 200<;>
OfCEDl.NT'S NAM[ (Fltl/. M ckl ~. L"t)
Frederick . Kuehn Sr.
... AGE - L.,' SlfthCI"r
(r."s,
4c UNDER I OAY
HOUAS I h.t'NuTES
I
71, LOCATION 0' OtÀTH (Enl" piau oflici.llr pronounced d.ad in 71, 7Þ, 7,.)
HOSPfTAL OR OTHER INSTITUTION - fåm. (It 1101 In ,"lItl, ".., ,'tHI .ftd num~/J
CovE.o.lÁf\IT" . ' <::$0 H bt J1I I,.IQ L
SOCIAL SECURITY NUMBER
CITV. VILLAGE. OR TOWNSH'P OF DEATH
SÅMIIII4"J t!../7'Y
S'A4,w,."",
II. BlRrHPlACE (C~. MId
Sr,t, Of fo'~ CDunrry)
10<, LOCALITY (Choca on< /lor "'" .".<'~)
o INSIOE Cm OR VILLAGE or
Ii TWP, or Saginaw
Foundry
lOcI STRHT AND NUMaER
10. CURRENT RESIDENCE - lOb COUNTY
STArE
"'1
100, ZIP cOO!
':fits r:-tllE 0"1('5 ()~
'1r603
Saginaw, MI
U MARITAL STArus - M.med. 13, SURVIVING SPOUSE
"""It Miltit'd. WldoWf'd. i" WlI" "V, lI"m, ~IOIr ItlSt m""~)
OI...,ed ISpoa~
A~~ Caroline West
19 MOTHER'S t-IAM( (rU", MI4Ø". SuI",,,.,. brIm.. ,.'" 1N,,,.rlI
Frances Gricar
1< WAS OEC[QENI EVER
IN US AIIMED rORCES'
,$p«Jfy rtS: Ø1 NoJ
Yes
J 5. ANCUTRV - Melltan, Puar10 AlGIn. OJ..". Cuttll or South
AIntftcatI. Cltana. athlr HdpanlC. AfIG-Nnencan, Alab,
E_, fltnell, rln...... tic, (Sp«>~ below)
German
II FATHER'S NAME (f",'. M_. ¡..,)
Hubert Kuehn
16 R4C(.. Am.flun Induln. 8b1Ck, Wht., ,tc
It MUIn, p, nlhon..lv I.. Chinen.
FilipinO, À$Uln Inc:liln. ~c (5p« fy beJøIt)
\NH I Te
--
20. INfORMANT'S NAME a",./ptllt')
Ca.roline Kuehn
11, METHOO OF DISPOSITION - au"'l. Cltmlllon.
Rønov.l. Don,tion, Otnt, (IIWC'/Y)
2Ob. MAIliNG i\OOR[SS (Sf'Nt and Nuwdwt ., Rut.., Rout. Num_. City øt VII.. 51.'., lIP CoiI.J
#5 Five Oaks Drive. Saginaw, Michigan 48603
221. PlACE 0' DISPOSITaoN (N~MI 0' CtIN,.,,,. Cr#fftl'O'Y.
ØI Ø(ftrt pUe.)
22b. ~OCATION - CII.. or VtlylÞ. State
St. Andrews
Cemetery Saginaw, MI
2~ NAME AND AODRESS or , ACILlTV
W.L. Case & Company
4480 Mackinaw Road, Saginaw,
2<. LICENSE NUMBER
(øf LternSH)
b
00 .!!!!! InU, (h. mod, 01 "'IRI. Jueh .II, ",tchac Of ,",p1fllory
I ~:::=W~~¡¡¡~··-:
I Onsel M~':::9;'lh
I/~~e.f~~
I
I
I
I
I
IMMEO'ATE CAUSE (f...,
dlMlM Of candlhaft --Þo
,."'",'" ." _ath)
..
Atl.)"TÇ' /I1'lOC,i1fl,bC 11'- ,~F,t,.e.crt~
DUE TO (OR AS A CONS£QUENCE or).
$eql.ltt"11otIIt '''' condlllON, {
"MilO Imrnldl.le
~~N\",., (;tOERl YING Þ
CAU$[ (Ctl"" 01 .n uty ,.
lhit aNt...cd evtnll
rftuhtrll In de.th) lAST
d,
PART II Olh,1 '.."'fQnl condlliOf\l tonl'lblltl"l '0 Halt\, but not relultl", In I'" ""dlrty'"l tauN IIVI'" In P.11 I
DUE TO (OR AS A CONS£QuENC~ Of)
DUE TO (OR AS A CONSEQuENCE Or)
271 WAS AN AurOPSY
P!AFORMED!
IY" '" N.)
Ub WERE.,~!JTOPSY,JINOINGS
AVAlLABLEPAIORIO
COI,!PlUION or CAUSE
0' OEArH' ('''.' No)
NO
21.
31to..tlt 0 TN UN ,.",inld Ind dttttmaned not 10 ~ . m,d"" "'IIW'ÞI"S m..
::~'" 0 Oft..... bu61 at ftMrIN\thon Md of inwe&tlpttOf'l, 1ft ... op,,"øn death occur1ecl
T' .t Ih. "tN, dil. ,nd ptlu Ind due 10 the c.USI(&) and INnnø K.ttd.
lª
!i1 þE~lttt,(1 2S' 2GIOO
tj ~0cI. NAME 0' ATTENDING PHYSICIAN IF OTHER THAN CERTlFt[R (r....., "''''')
'1>/l. l-E"STEI?- t.J r:B ß
IUI. .tWJ T,U. ~
31b It. ... (Mo. o.r, V, J
J h CASE NuuØtR
310 PRONOUNCED DEAD 1M.,. 0.., V, J I. TIME or DEATH
ON
lot
STATE O&:~A
COUNTYOP8M!/NA
I ~~~!!ebyf "'CInlfylrfaT1hTiJ.lï In exact reproduction of the
OCt "~I' or the penson named therein 81 It now appears In the
permanent records of the Saginaw County Clerk's Offfce ThIs
record Is not valid without the rall8Cf seal of the departinent.
S~p 0 4: 2008 ~~.A\
"-s-;~
SagInaw COllfìty Clerk
" JJo.ACC ~ICIOE, 110M.. NATURAL
, OR Pt:HOING INVEST. (s.c,/Y)
¡...f'A:
INJURV AT WORK
fS-./Y Y.. .. NoI
J~Þ DAlE Of INJURY fM.. CIa., V'I Uc:, TIME Of INJURY
M
Jh. NAME AND ADDRESS Of P£ASON WHO COMPLETED CAUSE Of DEATH (ITEI,! 26) I''''' '" """')
'A (.!.I'..(l..:,/ ~6fLl c..¡L. 'J:>, ð ' '1 (Jo f!..J:¡ OP61l. £-;1 ~A-G. ( /oJ ¡µ1)
JJci
331. PLACE or INJURY - AI "....., "'m. 'trill. ''''0'1,
. ollie. budc:h"l. .Ie (S(I«lfr)
331 LOCATION· SIIII' ., R r 0 N.
Cdy. VIII,p or T..p
St.,.
]oIÞ, OATE FILED I_'". Clay, Ya,)
DECEMBER 28.