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Home My WebLink About944271 RECEIVED 12/22/2008 at 1 :01 PM RECEIVING # 944271 BOOK: 711 PAGE: 482 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY AFFIDAVIT OF SURVIVORSHIP OOÜi482 HARVEY H. WAKEFIELD and GEORGE W. DRUBE, being first duly sworn upon their oath, depose and state as follows: 1. On the 27th day of October, 2008, MARGIE LILLIE WAKEFIELD, a/k/a MARGIE L. WAKEFIELD, passed away, as is evidenced by the official certificate of death attached hereto and incorporated herein by this reference. 2. At the time of her death MARGIE L. WAKEFIELD, jointly owned certain real property with HARVEY H. WAKEFIELD and GEORGE DRUBE, as joint tenants with rights of survivorship, said real property being located in the County of Lincoln, State of Wyoming, and more particularly described as follows: Lots 16 and 17 of Southland Park Addition to the Town of Diamondville, Lincoln County, Wyoming, according to the plat of record in the office of the Lincoln County Clerk, EXCEPTIONTHEREFROt--1: that 22.00 foot No:r'therly portion of Lot 17 of Southland Park Addition, Town of Diamondville, County of Lincoln, State of Wyoming, more particularly described as follows: Beginning at the Northeast corner of said Lot 17 of the Southland Park Addition; thence South 72°32'51fl West along the Northerly boundary line of Lot 17, distance of 99.18 feet; thence in a Southeasterly direction along the arc of a curve to the left, the radius of said curve being 50.00 feet, a distance of 27.93 feet; thence North 72°32'51fl East, a distance of 82.68 feet to a point on the Eastern boundary line of Lot 17; thence North 17°27'09fl West along the Eastern boundary line of Lot 17, a distance of 22.00 feet, to the point of beginning. ûOG4S3 TOGETHER WITH a 1984 16 x 72 Westpark Mobile Home, serial number CMC5C05933428, and any and all improvements, buildings and appurtenances thereon situate or in anywise appertaining thereunto. Said real property was originally conveyed to HARVEY H. WAKEFIELD, MARGIE L. WAKEFIELD and GEORGE DRUBE, as joint tenants with full rights of survivorship, by Warranty Deed dated July 8, 1998, and recorded in the Office of the Lincoln County Clerk and Ex-Officio Register of Deeds on July 15, 1998, in Book 414 at Page 497. 3. At the time of her death, MARGIE L. WALKEFIELD, jointly owned certain other real property with HARVEY H. WAKEFIELD and GEORGE W. DRUBE, as joint tenants with rights of survivorship, said real property being located in the County of Lincoln, State of Wyoming, and more particularly described as follows: Lot Thirty-Three (33), Spring Canyon Ranch Subdivision, Lincoln County, Wyoming. Said real property was originally conveyed to GEORGE W. DRUBE, MARGIE L. WAKEFIELD, and HARVEY H. WAKEFIELD, as joint tenants with full rights of survivorship, by Warranty Deed dated May 26, 1998, and recorded in the Office of the Lincoln County Clerk and Ex- Officio Register of Deeds on October 5, 1998, in Book 419 at Page 066. 2 000484 4. By reason of MARGIE L. WAKEFIELD'S death, we are entitled to ownership of the above-mentioned real property, as joint tenants with rights of survivorship. DATED this 15 day of OU..( 1-....... \;. ~.../ , 2008. j ~~~:7 d:~;~-r-d~ ,,~ ?V j0-~ GEORGE . DRUBE THE STATE OF WYOMING ) ) ss. COUNTY OF L;~L~\~ ) SUBSCRIBED AND SWORN to I.r::; day of 'Ùel -<,,,,,,Iou" and acknowledged before me this , 2008, by HARVEY L. WAKEFIELD. WITNESS my hand and official seal. GL<J,~ I'YL ~.<iJ Notary Public My Commission Expires: 10 -Ic ··;lð 1/ "'*+'Ô....'\!Io1~~ Paula M. BOWIiI:f1.~ Notary Public County of :l>'~"';~ State of Lincoln ~. ~1! Wyoming My Commission Expires 1^ -I '1. c::t() II ..,.....",.~.jI~....,...,.. 3 THE STATE OF WYOMING COUNTY OF L,'n (cJ lv'\ ) ) ss. ) SUBSCRIBED AND SWORN to /5 day of Ì) e l.("h L;>v{~ OOô485 and acknowledged before me this , 2008, by GEORGE W. DRUBE. WITNESS my hand and official seal. My Commission Expires: IC'!- q . dO II f/Iþ-~~"""'~I-~ C" M. Bowl'" - No"~ Pobll, ..1./ . County of" \ State of Lincoln Wyoming My Commission EXI;ir~;" (0 ·1 l¡ - ~O II ~,~ti. a~ f}L (9.,h'2~__ ~~ary Public 4 LOCAL FILE NUMBER 139 STATE OF WYOMING DEPARTMENT OF HEALTH CERTIFICATE OF DEATH 00&486 STATE FILE NUMBER 1. DECEDENTS LEGAL NAME (Include AKA'. N .ny) (First, Middle, La.t) MARGIE LILLIE WAKEFIELD 2. SEX Female 3. DATE OF DEATH (MoID.ylYr) (Sp.11 Monlh) October 27, 2008 4. SOCIAL SECURITY NUMBER 520-28-1924 5.. AGE - LOll Blnhd.y (V..rs) 84 Minutes 6. DATE OF BIRTH (MoID.ylYr) May 28, 1924 >. In -ca: .~ 0 :1::1- "0 ~~ ,!C CU..J ii< Ea: OW OZ cu::l InUo {2 Green River Sweetwater IF DEATH OCCURRED IN A HOSPITAL: 8. BIRTHPLACE (CIty.nd .,.,. or lorelgn country) Cheyenne, Wyoming 11. EVER IN U.S. ARMED FORCES? OVES ~NO 12d. STREET AND NUMBER 12.. RESIDENCE - STATE Wyoming 9. MARITAL STATUS AT TIME OF DEATH o M.rri.d 0 M.nled. but ..p.r.l.d o Divorced 0 N.vor M.rrlad 12b. COUNTY Lincoln ~W\dOwed LI Unknown 10. SURVIVING SPOUSE (II wll.. glv. n.m. prior 10 IIrst m.nl.ge) 12e. CITY, TOWN OR LOCATION Diamondville 1146 Coalcreek Avenue ~YES 14. MOTHER'S NAME PRIOR TO FIRST MARRIAGE (First. Mlddl.. La.t) Lizzie Otton 12e. ZIP CODE 83116 121. INSIDE CITY LIMITS? ONO 13. PATHER'S NAME (First, Middle, L..t) Herman Otto Drube 15.. INFORMANTS NAME George Wakefield 15b. RELATIONSHIP TO DECEDENT Son 15e. MAILING ADDRESS (Stre.l.nd Number, CIIy. Slete, ZIp Code) 1105 Kansas Street. Green River, Wyoming 82935 LJ Removal rrom Wyoming 17.. PLACE OF DISPOSITION (Neme 01 . li'Vl!oil'ë qr ~rsm.tq¡y). vvnlti MOUmaln Crematory l?b. LOCATION - CITY OR TOWN AND STATE Rock Springs, Wyoming 19~~~Iit~té~fILITY Rock Springs, Wyoming 82901 16b. LICENSE NO. 485 1ge. NAME OF FACILITY Vase Funeral Home 22. TIME PRONOUNCED DEAD 1710 23. WAS CORONER CONTACTED? o YES ~NO CAUSE OF DEATH 24. PART I. Enter Ihe chain 01 events - dlseaae..InJuriee -or complications - that directly caused the dealh. DO NOT enter lermlnal event. such 8S cardiac arresl, resptralory arrest. or ventricular fibrillation without showing the eUology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional IIn98 If nee.nary. Approximate Interval: Onset to death IMMEDtATE CAUSE (Fln.t dl..... or condition r.Buttlng In death) Sequentially IIsl conditions, If any, leading to the caUlllllted on line .. Ent.r the UNDERLVING CAUSE (dteeas8 or Injury Ihatlnltiated Ihe even" reauUlng In death) LAST. .Aspiration Pneumonia DUE TO (or.8. consequence 011: 1 Month Stroke b, 4 Months DUE TO (or 8S 8 consequence 01): e. DUE TO (or as a consequence 01): d. >. In ã:a: ...w .!¡¡: Q.¡::: 8a: OW cuO In {2 PART II. Enter other stgnlflcanl conditions contributing to death but not resuttlng In the underlying cause given In Part I. 25. WAS AN AUTOPSY PERFORMED? o VES Q(NO 28. WERE AUTOPSV FINDINGS AVAILABLE TO COMPLETE THE CAUSE OF DEATH? 2? DID TOBACCO USE CONTRIBUTE TO DEATH? o YES ONO 28. IF FEMALE AGED 10-54 o Not pregnant within palt ye.r LI Pregnant at time of dealh . o Not pr.gn.nt, but pregnant wflhln 42 days 01 d.ath OVES IX NO o PR08ABL V 29, MANNER OF DEATH IX N.lurel o AccIdont o Suiclclo o UNKNOWN o Not pregnant, but pregnant ~ dBYI to 1 year before death c:J Unknown If pregnant wllhln the pasl year o Homicide o P.ndlng Invoatlgallon o Coutd not be determined 30. DATE OF INJURV (MoID.ylYr) 31. TIME OF INJURY 32. PLACE OF INJURY (Decedent's home, construction aile, forest, etc.) 33. INJURV AT WORK? 34. LOCATION OF INJURV (Slr..lend numbor, CIIy or Town, Slat.) 35. IF TRANSPORTATION ACCIDENT, SPECIFY: o Driver J Operator I:] Pedestrian o P....n .r 0 Other (Sp.el ) 36. DESCRIBE HOW INJURY OCCURRED. AND IF TRANSPORTATION INJURV, THE TYPE(S) OF VEHICLE(S) INVOLVED (Aulomobll., pickup, motorcyel.. ATV, blcycl., .Ie.) OVES ONO 3?. CERTIFIER (Ch.ck only on.) äPHYSICIAN - To the bill of my knowtedge, dealh occurred 8tthe time, date and pace, and due 10 the ça (I) and manner atated. o CORONER - On the bul, of examination, and/or Investigation opinion 8th occunw . date and place, and due to the cauae(l) and manner staled. Signature 01 Certifier 37b. DATE CERTIFIED (MoID.ylYr) J. Stephen Sloan, M.D., 1400 Uinta Drive, Green River, Wyoming 82935 38b. DATE RECEIVED BV REGISTRAR (MoIDaylYr) October 30, 2008 DATE ISSUED October 30, 2008 TIllS IS TO CERTIFY THAT this is a true COITect conformed reproduction of the original copy of the death certificate completed by the V ASE FUNERAL HOME and submitted to the VITAL RECORDS SERVICES, Wyoming Department of Health and Social /----Servl s,Division o~ H~alth and Medical Services at Cheyenne, Wyoming. ( -.., /, / i STATE OF WYOMING)ss .) - / COUNTY OF SWEETWATER V ASE FUNERAL HOME Subscribed and sworn to before me a Notary Public 154 Elk Street . 30th October 2008 Rock Springs, Wyoming 82901 ~.~ My commission expires on April 21, 2010