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RECEIVED 12/15/2008 at 11:27 AM
RECEIVING # 944157
BOOK:~1 PAGE: 93
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY I
AFFIDAVIT OF SURVIVORSHIP
I, JOHN RANDALL, being duly sworn under oath, state as follows:
00&093
1. Leana Randall has tenancy by the entireties with me in land in Lincoln County,
Wyoming, more particularly described as follows:
That land described in the Special Warranty Deed that was recorded in the
Lincoln County, Wyoming, land records in Book 558 PR at Page 81 on June 8, 2004 as
Instrument No. 899975, a copy of which is attached hereto and incorporated herein by
reference.
Said Special Warranty Deed creating the tenancy by the entireties is attached hereto.
2. I, John Randall, the surviving spouse of Leana Randall, hereby certify that Leana
Randall died on June 4, 2007. Attached hereto is an original copy of the Certificate of Death
issued for Leana Randall.
3. Pursuant to Wyoming Statutes § 2-9-102, I certify that the tenancy of Norman
Leana Randall has been terminated by her death, and that title to the above-referenced land is
now in the name of John Randall, a single man.
DATED this L day of December, 2008.
cJ~ tLLrr
¡1'0HN RANDALL
STATE OF WYOMING )
) SS.
COUNTY OF LINCOLN )
SUBSCRIBED AND SWORN TO before me by JOHN RANDALL this 8~ day of
December, 2008.
WITNESS my hand and official seal.
. - . .
M. KEVIN VOYLES - NOTARY PUBLIC
COUNTY OF STATE OF
LINCOLN WYOMING
MY COMMISSION EXPIRES JULY "16,2011
........
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~AR1YPUBLI
My Commission expires: þ?!1t / II
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)'June îr, 2Q07/
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This is a true certification of the document on file in the office of Vital
Records Services, Cheyenne. Wyoming.
.,.. GI~dYS K. Bré~de~.
Dep~\y State Registrar \ ..
This copy is, not valid u~~~.:~Jrepared on papêr with an engraved border.