HomeMy WebLinkAbout873826
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My Commission Expires:
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State of Washi~ton
County of ~ ~() ~
,~The foregoin ·r.strume.n~}~~~~iÜr~~~~ow!e. dged before me by Sheree L. Raska this
~l day of ' i,l,·,\)-Vè-e,"Q<DO,'.
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Witness my hand arÍd düicið'l-'S'êaJ.~? J I'
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Sheree L. Raska
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Dated:
FURTHER AFFIANT SAYETH NOT.
4, That by reason of death of said Lewis D, Roberts and by reason of S 34-
6-102 of the Wyoming Statutes (amended 1977), the decedents interest
and title in said conveyance has terminated and title to the real property
conveyed thereby has vested absolutely in Betty L. Roberts continuously
since the death of the said decedent.
LESS AND EXCEPT the land contained in Warranty Deed recorded April
29, 1985 in Book 225PR on page 754 of the records of the Lincoln
County Clerk.
3. That said Lewis D. Roberts died on the !À.3 day of ~,
and a copy of the original certificate of death, certified to as true an
correct by public authority in which the original of said certificate is a
matter of record, is attached hereto as Exhibit" A",
Commencing at a point which is 50 feet West from the Southeast Corner
of the NE Y4 SE ~ of Section 3, T35N R119W of the 6th P.M., Lincoln
County, Wyoming and running thence West 198 feet, thence North 1320
feet, thence East 198 feet to the west edge of U.Sh Highway 89, thence
South along the West edge of said Highway, 1320 feet to the point of
beginning.
2. That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 225PR on page 114 is recorded a Warranty Deed. The
Warranty Deed, dated the 21 st day of March, 1985 conveys unto Lewis
D. Roberts and Betty L Roberts, as Husband and Wife as Tenants by the
Entireties the following described property, to-wit:
I, Sheree L. Raska, being of lawful age and first duly sworn according to law,
upon my oath, depose and state: BOOK4~~?_PR PAGE:] _ª_J,
1. That I am of adult age, a resident of 18325 West Henderson Road,
Medical Lake, WA 99022, and the Affiant herein.
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AFFIDAVIT TERMINATING ESTATE BY THE ENTIRETIES
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THE COUNTY OF
SS.
L. ! ¡ ,J C CI i . . ;::; L:(::!:!~i : i\!
THE STATE OF WASHINGTON
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372-4
I will make my periodic payments at .... ..~Q4 W~~.~INGTPN ~J.~~n, ~fJ.Q~. WY.Qm 9... ......... ........... ....
.............................................................................................................................
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........ .. ....... ................... .. ...... .... .. .. .... or at a different place if required by the Note Holder.
o B. FUNDS FOR TAXES AND INSURANCE
Uniform Covenant 3 of the Security Instrument is waived by Lender.
BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in
this Payment Rider.
~.....~-<d:r.f.,.,.d.... (Seal)
SANDRA HENDERSON
-Borrower
.......................................................... (Seal)
-Bonower
Bankera Syatama, Inc., St. Cloud, MN Form MPFR·PR 8/26/2000
(page 2 of 2 pages)
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08738'26
STATE OF WYOMING
DtVISION OF HEALTH AND MEDICAL SERVICES
,-, 8 ¿1
,) !
CERTIFICATE OF DEATH
TYPE
OR PRINT
IN
PERMANENT
INK
FOR
INSTRUC110NS
SEE
HANDBOOK
LOCAL FilE NUMBER
DECEDENT NAME FIRST
MIDOLE
STATE FilE NUMBER
DATE OF DEATH (Mo.,DIJY, Yr.)
LAST
SEX
Lewis
David
Roberts 2. M.
AGE Last Birthday UNDER 1 VE:AR UNDER 1 DAY
IY".) MOS. DAYS HOURS I MINS.
5a. 58 5b. 5c.
CITY. TOWN OR LOCATION OF DEATH
3Pctober 23 1988
DATE OF BIRTH (Mu., V4Y, Yr.)
6June 5 1930
COUNTY OF DEATH
IF DEATH
OCCURRED IN
INSTITUTION.
SEE HANDBOOK
REGARDING
COMPLETION OF
RESIDENt:;:
7c. Freedom 7dLincoln
MARRIED, NEVEA MARRIED, SURVIVING SPOUSE fl!wif_,g;1IØmøiJø",.4"..j WAS DECEDENT eVER IN U,5.
WIDOWED. DIVORCED ISp.â/y} ARMED FORCES?
10. Married 11.Betty Louise Charlesworth ~\tifYY"d")No
USUAL OCCUPATION IG;!.. It¡,,J oj wtJrlt dQ'" dU'¡ff& mod uf KIND OF BUSINESS OR INDUSTRY
wør4j"g lifB. .v~. if retired)
14a. Sales erson
CITY, TOWN OR LOCATION
9. U.S.A.
INSIDE CITY LIMITS
(SJWâ/y Y r:¡ f " Nfl)
15b. Lincoln
MIDDLE
1 c. Freedom
LAST
FIRST
MIDDLE
51. No
LAST
16. Charles S Ivester Roberts
INFORMANT NAME (ryp.o,.Prin,) MAILlNGADDAESS
Vera Hawkins
CITYORTOWN
ZIP
STATE
18b. P. O. Box lOgO
CEMETERY OR CREMATORY NAME
83110
CITY OR TOWN
STATE
Afton WY
LOCATION
19c. Etna Cemetery
NAME OF FACILITY
19d. Etna WY
NUMBER ADDRESS OFFACILlTY
22b. /0'" ~ s- 88
PRONOUNCED DEAD 1M... Vo,_ y..¡
22d. ON /ð - ~ ~ ,. 1f9 221. AT . ~s- I'M
~ Q9';.. (lleK./'oIV té.lk> ~
DATE RECEIVED BY REGISTRAR (Mo.. Va . Yd
22c.
PRONOUNCEO DEAD IU..,)
CONDITIONS
IF ANY
WHICH GAVE
RISE TO
IMMEDIATE
CAUSE
STATING THE
UNDERLYING
CAUSE LAST
1+
(b)
I Imervalbel"Neenonselanddealh
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IlnlervalbelweenOnSel¡nddealh
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DUE TO, OR AS A CONSEaUENCE OF:
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OTHÃ7=,TlONS-COndltiOnS conlrlbuting 10 dssth bul nol related 10 cause given In PART 1 ta)
ACC., SUICIDE. HOM.. UNDET., DATE OF INJURY 1M... Doy. Y..)
OR PENDtNG_INVE?tSP<~ifJ- r7Þ/
28a. ~ 28b. f:;À-'2ß';-í ¡r 28c.
INJURY AT WORK (Sp.cV, Y., PLACE OF INJURY At home. farm. alreel, faclory, ofllce building,
M...N.' ele. IS~
281. 'lJ 281. ~
THIS IS TO CERTIFY
of a record on file
Cheyenne, Wyoming.
that this reproduction is a true copy
in Wyoming Vital Records Services,
If this copy does not bear a
of the State Registrar is
official certified copy.
raised seal and the signature
not in RED, this is not an
Date Issued
November 2, 1988
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4:11¿-
E# 1138728 BK1598 PG2594
State Registrar
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