HomeMy WebLinkAbout943419
STATE OF WYOMING )
) ss.
COUNTY OF LINCOLN )
RECEIVED 11/5/2008 at 10:51 AM
RECEIVING # 943419
BOOK: 708 PAGE: 524
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ÜOô524
AFFIDAVIT OF SURVIVORSHIP
NORRIS W. THOMPSON, of lawful age, being first duly sworn according to law upon his
oath, deposes and states:
1. That pursuant to a Warranty Deed recorded in the office of the Lincoln County
Clerk, Kemmerer, Wyoming, Ann S. Olson, sole owner, deeded the following
described property to Norris W. Thompson and Carolyn S. Thompson, as joint
tenants with rights of survivorship. The property is described as follows:
Lot 632 in Star Valley Ranch RV Park Plat 2, Lincoln County,
Wyoming as described on the official plat thereof
SUBJECT TO any easements, reservations, restrictions or right-of-
ways of record, of sight or in use.
Said Deed is dated June 29, 2006 and was recorded in Book 625, page 612, in the
records ofthe Lincoln County Clerk on July 5, 2006.
2. That on the 29th day of August, 2008, said Carolyn S. Thompson died in St. George,
Washington County, Utah, and was on that date a resident of Hurricane, Washington
County, Utah. A certified death certificate of said decedent is attached hereto.
3. That pursuant to the death of Carolyn S. Thompson her interest in the property
described above terminated and sole title to the above-described property is now
vested in Norris W. Thompson.
4. This Affidavit is made pursuant to Wyoming Statute § 2-9-102 and shall be recorded
in the records of the County Clerk wherein the deceased resided or owned real or
tangible property and a certified copy thereof shall have the same force and effect as
an original.
Further the affiant sayeth not.
Dated this 13th day of October, 2008.
~Æ~~
NORRIS W. THOMPSON
STATE OF UTAH )
) ss.
COUNTY OF WASHINGTON )
Subscribed and sworn to before me, a Notary Public, by NORRIS W. THOMPSON, on this
13th day of October, 2008.
My commission expires:
;2 -/~( (
.···ó·.~·;......-
",,<~c"'~~~}. CYNDY M. HYATT
/J~·ø-.:·' \;~¡ NOTARY PUBLIC· STATE of UTAH
~~\ i¢.ii ..1;;, 754 NORTH STAR DR.
\:>-.. ,,~.~l ST. GEORGE, UT 84770
··;:.:.=iÚ:¡:·;;;···· COMM. EXP. 02/01/11
CERTIFICATE OF DEATH
State File Number: 2008009876
"-..,
Carolyn Shillingford Thompson
OOG525
\
DECEDENT INFORMATION
Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
J Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
/
August 29,2008
St George
85
Glendale, California
No
Norris W Thompson
Printing
,Hurricane, Utah"
' Marion Shillingford Greene
Irish Cottage
Time' of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
/I
I
INFORMANT INFORMATION ." ....'
Name: Norris W Thompson Relationship:
Mailing Address: 150 N. 370Q W. #135, Hurricane, Utah 84737
13:25
Washington
September 11, 1922
Female
Married
Shipping Clerk
Associate Degree
George Herbert Jones
Nursing Home/Assisted Living
Husb¡}nd
DISPOSITION INFORMATION
Method of Disposition: Cremation ..'. . ., ' Date of Disposition: September 3,2008
Place of Disposition: Hites Crematory;Henderson, Nevada
FUNERAL HOME INFORMATION
Funeral Home: McMillan Mortuary ...
Addres~ 265 West Tabernacle Street, SìGewrge,Utah84770
Funeral Director: RobertKiJ1cMi/lan
MEDICAL CERTIFICATION
Certifying Physician: Robert P~igne" MD, 515 S. 300 E. #105, Saint Georgé,Utah 84770
CAUSE OF DEATH
Failure to thrive ..'
Chronic lung,' heart. and liver disease
Tobacco Use: ~nknown if User
Medical Examiner Contactecj: No Autopsy Performed: No Manrfer of Death: Natural
~
/
September 3,2008
\
This is an exact reproduction of the document registered in the State Office of Vital StaJistics.
Security features of this official document include: Intaglio Border, V & R images in top cycloids,'.
ultra violet fibers and hologram Image of the Utah State Seal, over the words "State of Utah". This
document displays the date, seal and signature of the State Registrar and the County/District Health Officer.
I
I
1~111111111~1~llllllnl~1 5J"",~. ~~
* 0 Ej ~ 6 7 9 6 ~ 8 * Director/Health Officer
~êH
Barry E. Nangle, StatØ. Registrar
n",,¡__ _" \1=.......1 c:'&......."'I.....&I__
~n"nt"/nldri,.t . ....Ith n..n..rtm..nt
./
/
/
/
"-