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RECEIVED 12/18/2008 at 10:11 AM
RECEIVING # 944216
BOOK: 711 PAGE: 338
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
':-00338
THE STATE OF WYOMING )
)ss.
COUNTY OF UINTA )
DANIEL A. NORRIS, being first duly sworn upon his oath,
deposes and states as follows:
1. On the 1st day of December, 2008, my mother, MARY LOUISE
NORRIS, died, as is evidenced by the official certificate of death
attached hereto and incorporated herein by this reference.
2. At the time of her death my mother jointly owned certain
real property with me, said real property being located in the
County of Lincoln, State of Wyoming, and more particularly
described as follows:
Lots 265 and 267 of the Lake View Estates, a subdivision
of Lincoln County, Wyoming, as surveyed, platted and
recorded in the Office of the County Clerk and Ex-Officio
Register of Deeds in and for Lincoln County, Wyoming.
3. Said real property was originally conveyed to GLEN D.
NORRIS, MARY LOUISE NORRIS and DANIEL A. NORRIS, as Joint Tenants
with Rights of Survivorship, by Quitclaim Deed dated January 10,
1997, and recorded in the Office of the Lincoln County Clerk and
Ex-Officio Register of Deeds on January 14, 1997, in Book 392PR at
Page 722.
4. By reason of my mother's death and the previous death of
ûOö339
my father, Glen D. Norris (as evidenced by an Affidavit of
Survivorship recorded in the Office of the Lincoln County Clerk and
Ex-Officio Register of Deeds on February 8, 2000, in Book 441 at
Page 296), I am entitled to sole ownership of the above-mentioned
real property.
/7
day of ,J)ece.mbe-r
, 2 0 0 t.
DATED this
¿adN~ISJ!~
SUBSCRIBED AND SWORN to
I 7 H-. da y 0 f i~-ec...p£N'\. h. -er
and acknowledged before me this
, 200¥, by DANIEL A. NORRIS.
WITNESS my hand and official seal.
My Commission
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iSTATEOF WYOMIf\JG'd
DEPA~TIVIENr OF I¡IEALTH\
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DEATH CERTIFICATE
Mary Louise Norris
Female ""','
May 15, 1934
"... d"'" ,... .......... .."." ...._.,'
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/St~tedFilJ!Num6er: 2608-003511/
dSocia 'S~curity Nurpb~r:- , ..
~ge at!h~ T!.m~ ofpsath: 7 4 yè~fs
Decedent:
Name:,
. .. ·.Gender:·
Date qf Birtb:
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Date and Plaée of Death:
D~trÒf [)ëåt~: .... Deçemb[fr01..~ð~8tÇtuàl,:'
City of Death, . Evanston. .d. "". ...,..,>-.
Location: Decedent's home·· .........
.....,. . .' ... .... ....,) .' "" ' .,'.,' '.'.' ",',
.... Additional DeêedentlriformaÌjon:\i. . .
....... .····~~~~~~:~h:.····· ·.·~~;~~~g~~nwJo~r~;ing.·.·.
.... Marital Status: ..·Widowed/ .........
Arméd Porc.ës: NO ····....t. ....
Name of Father: Dino DiTUllio
..MI.. faiden t-Jt~mE:}.o.... ffl;'1Do.th..~~.:1 ALouNi~e.. .. .D.05~~.nce
n orrpan. ..... ....ahle. Orps ,/ . .
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Disposition:
Method 9fDispositjon:
Plaçe ofPi$þo~iti0r.:.)
~Fq~~*â~~~&.~ter, SqÙth0o~åa~, U~~h'
.. ··~~~i~[;I~~~~.orr)Cilityhr~i)dàll FÜh~r~rHgmî?i' Evafi5tònt'Wyo~¡þg
,\ . . ... . .. ... .. ....."
Cause of Death: . . ...../.i.. .. :.d ..'
Thª imm.e.dif1teeaµsl?/s Iisttfdonth8;fir9tFne:/9I1ow~d b Yflny: ufy:Je'r!yir¡g elf! u.~es.
(a)çh.rorllc.ob~trUçtlyePulQ1o. na.fY pls~ase ......'....:., .:.\/ )...... " ...)" "\,.'
Other Significaht Goriditions:['JotRecofded ......... .. ............., ........,..,
. Manner of Death:
r~gm~~q~b~~~.~r~~~~··~·~·~é;,.·\f19rlniriQ
pecember 92,2008 .
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This is a true certification of the documant on ¡ile in the offica of Vital
Reçords Services. Cheyenne, Wyoming,
.' ""'. .;. '';.: :-:
DATE ISSU~p:i:)ecember O~,?OOê
.... .,. .
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Ò)adys K. Braeden ..
Deputy State Règlstrar'.,
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}'hìs copy is not valid lI~less prepared on p~per with,~.~, engr.~,~~~...?or~.~.~: ...