HomeMy WebLinkAbout873863
....
State of W as~ton
County of 'JTSð µ IIIII .
\\\' ","
\\\ ~ !-A '"
The foregoing i~~~$~', ~ledged before me by Glen Doyle Walker this y!!:=.
day of May, 2001. ~ .::j......~~mAR~'~~ ~ ~
.. ....., Y " -
... ~ \'" ':.:
: : -+-f-': =
~ en. '\ PUBUC /~ ~ §
- ~~' 7."> rf),' ¡r ...
.. ~'" <.8 - \,)1'", " ¡ ......
..- I~ \ :
-:,.., ""I'tl~~ ~"
--~"'O¡: W~X\ \\\\ .
My Commission Expires: '1Þ-li(:(. .1\
-V~0~
(7--VJ?_ Notary Pubhc
f#-j/L ~~.
J1 'I;' Glen Doyle Walker
day of June, 2001.
Dated this ~
BEGINNING at a point 10 rods ~.est from the Northeast corner of Lot 1 of
Block 27 to the Town of Afton, ¡ncoln County, Wyoming Townsite, thence
South 20 rods, thence West 10 rod ¡ thence North 10 rods, theuce East 5 rods,
thence North 10 rods, thence East : rods to the POINT OF BEGINNING.
This affidavit is intended to termi~late the life estate of said Glen P. Walker in the
following described property:
That I know of my own knowledge *at Glen P. Walker in the above described Quitclaim
and mentioned in the attached Certified c~ipy of Certificate of Death was one and the same
person.
~
That I was well and personally aCj¡iuainted with· Glen P. Walker as described in that
certain Quitclaim Deed dated January 13, 1995 and recorded January 18, 1995 in Book 363PR
on page 659 of the records of the Lincoln ~ounty Clerk.
If
That I am a citizen of the Unite Sta/les of America and over the age of 21 years, and a
resident of Belfair, Washington.
I, Doyle Glen Walker, being first duly swqrn on oath, depose and say:
01 Jim j 3 Pi''! 2: 35
JEAN¡\IE ,~\GNEH
¡<HrfMEHËFt WYOMING
Boq~K 46~PR PAGE..A..3.A-
COUNTY OF
STATE OF WASHINGTON
SS
AE¡FIDª.JI~ 8 6 3
f\ECEIVED
LINCOLN COUNTY CLERK
~"OÒ
-
-
O~~73~63
,;¡:r.3/
STATE OF WYOMING
DEPART lENT OF HEALTH
435
STA iE OF WYOMING
DEPA tMENT OF HEALTH
CERTllcATE OF DEATH
STATE fiLE NUMBER
3. DATE Of DEATH (Alo., Day, Yr.)
TYPE
OR PAM
..
PERf.WENT
8lJCK
INK
FOR
INSTRUCTIONS
SEE
HANDBOOK
LOCAL fiLE NUMBER
1,OECEDENT·NAME FiRST
MIDDLE
LAST
2. SEX
GLEN
MALE
AUGUST 21, 1997
6. DATE OF BIRTH (Mo., Day, Yr.)
... SOCIAL SECURITY NUMBER
5c. UNDE 1 DAY
.......
1909
AUGUST 14,
520-05-7829
7L PlACE OF OEATH (Check only one)
~,
Inpallent 0 EA/Outpatlent 0 DOA
E (" nal lMr/tuUon. fII... .11Hf IfId fMMT'Ibet,
7d. COUNTY OF DEATH
7b. FACIU
STAR VALLEY HOSPITAL
8. STATE OF BIRTH (II not In U.S.A., name cOc.lntry
LINCOLN
WYOMING
11. WAS DECEDENT EVER IN V.S: AR.....ED FORCES?
(Specify )'N or no)
12þ.KIND OF BUSINESS OR INOUSTRV
NO
COUNTY ROADS
13a. RESIDENCE· STATE
13b.COUNTY
WYOMING
LINCOLN
FIFTH AVE.
13e. INSIDE CITY UMITS?
(Speclty )'OS '" nol
Malden Surname
PHARES
MAE MERRITT
19&. INFORM....NT -NAME(TweorFWnt)
NELLE WALKER
1ab. RELATIONSHIP TO DECeDENT
WIFE
.. .
ZIP CODE
t ge. MAILING ADDRESS
BOX 243
83110
CITY OR TOWN
STATE
WYOMING
. .
44. EAST FOURTH AVE.
ocoorre
230. HOUR OF DE,4,TH
M
23e, PRONOUNCED DEAD (HOIIJ
WYOMING 83110
PART I. Enter the diMa..., I~urlea. 0 C CIIt10na that cauaed death: DOne! enler-
28, or reaplratory a"eet. Ihoçk, or heart ,.ilure. Lilt only one Clute on each line.
IMMEDIATE CAUSE (Final
disease or condition
resulting in death) ..
Aøp/'o (lmate
I mlerval Between
IOnaet .nd ONth.
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
27. AUTOPSY rSpeofty 28. WAS CASE REfERRED TO CORONER
ret Of M (Spec"V)'ll or no}
b.
5equentlally llal conclitiorw.
II any, leading to Immediate
c:a~e. Enter UNDERLYING
CAUSE (OJ..... Of Injury
Iha1 Inlllaled eventl
ruulllng In death) LAST
o
'-----
DUE TO (OR A$ A CONseOUENCE 0 'I:
d.
MRT II. OTHER StGNIFICANT CONDITIONS· Condition_ contributing 10 de,tn but not rela tel to cause given In PART I.
~$-
/
c$ VR 2-89
4104 15M
NO
3Od. DESCRIBE HOW INJURY OCCURRED
NO
30.. DATE OF INJURY
ram.., Day,_)
30b. TIME OF
$NJURV
3OC, INJURY AT WORK?
(Spec/f'V )1\1.1 01 no}
28. MANNER OF DEATH
Nltural 0 PendIng
Invtttlgatlon
M
Accident
301. LOCAl1ON (SIIMt and Number or Aural Roote Numbor, City or Town, State)
Suldde 0 Could nee be
Delermlrwd
30.. Pt.ACE OF INJURY·,4,1
office building, etc. (
, farm. .treet, factory,
~I
Hom_
34385
This is a true and exact reproduction of the document on file i i the office of Vital
Records Services, Cheyenne, Wyoming,
o/~,¿¿ Þ1f7
Lucinda McCaffrey .
Deputy State Registrar
DATE ISSUED:
SEP - 2 1997
-
-
-
AFTON
M