HomeMy WebLinkAbout946178
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6010817401
STATE OF WYOMING )
)
COUNTY OF LINCOLN )
SS.
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AFFIDAVIT OF DEATH
I, Marv L. Gardner, being of lawful age and first duly sworn according to law, upon
my oath, depose and state:
1. That I am of adult age, a resident of Afton, Wyoming, and the Affiant
herein.
2. That said GLENN L. CORSI on the 22nd day of October, 2008, died
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".
3. That by reason of death of said Glenn L Corsi and by reason of 2-9-102
W.S. (1980), the decedent's interest and title in said conveyance has
terminated and title to the Certificate of Title for Motor Vehicle for the
1978 Chickasha Trailer Caravan 16' X 85' - VIN #4205W conveyed
thereby was vested absolutely in Glenn L. Corsi and Eleanor Mae Corsi
as of the 9th day of May, 1978, continuously since the death of the said
decedent.
FURTHER AFFIANT SAYETH NOT.
Dated ...;J - / ;y- .;2 ¿'7(?t! 9
State of Wyoming)
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/tt~ll .".{ ¿:¡tMß~
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a L. Gardner
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County of Lincoln)
The foregoing instrument was subscribed
Gardner this i/J-I-ß day of .JaMar)', 2009
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Witness my hand and official seal.
and sworn to me by Mary L.
County of
Lincoln
Sta te of
Wyoming
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tary Public
LAYNA HADERLlE . NOTARY PUBLIC
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RECEIVED 3/27/2009 at 4:23 PM
RECEIVING # 946178
BOOK: 718 PAGE: 867
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF IDAHO
DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
,:'.I:lil';:¡ CERTIFICÄTE OF DEÄTH
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iNPvEYM!B:E;R 17, 2008
State File No.
2008-09187
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SOCIAL SECURfTY NUMBER
AGE
DATE OF BIRTH
86 YEARS
OCTOBER 16, 1922
BIRTHPLACE
PLACE OF RESIDENCE
(
GROVER, WYOMING
AFJON, WYOMING
, ,MARITAL 8TATUS A-rTi~E OFDft-TH
'...,¡WI D;I¡l~:'E D~:,;¡
FA THEA - NA..MŒ;;':: _' :\','¡\" '.
ARCANGELO CORSI
NAME OF SlJR\IlVING SPOUSE (If 'IoifÐ, maiden namfJ)
WAS OECEOENT EVER IN
U.S. ARMED FORCES?
NO
BIRTHPLACE
\
WYOMING
MOTHER· MAIDEN rJA:.1E
BIRTHPLACE
EDITH LEE
WYOMING
CREMATION
FUNERAL SERIIICE LICENSEE
,METHOD OF DISPOSITION
BOB M. CORNELISON
NAME AND ADORES8 OF FUNERAL FACILITY
SCHWÄ~ MORTUARY, AFTON, WYOMING
DATE OF DEATH TIMEOFOEATH
CITY.TOWN OR LOCATION OF DEATH
COUNTY OF DEATH
12:00 NOON
POCATELLO, IDAHO
BANNOCK
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Approximate Interval Between
Onllet and Death
1 WEEK
& ¡SURGERY
1 WEEK
1 WEEK
RENAL INSUFFICIENCY, CHF, MYOCARDIO INFARCTION, DEMENTIA
WAS AN AUTOPSY
PERFORMED?
NO
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but nol reeuldng In the underlying cau.. given above
ACCIDENT
NAME OF CERTIAER
dM QUICK
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
TITLE '"''
MANNER OF DEATH
CORONER
OCT!. "15,
LOCATION WHERE INJtJHY QCGLlRRED
425 SOS'PRING CREEK DR, SODA SPRINGS, IDAHO
A.M.
HOME
DESCRIPTION, OF HOW IN,¡UR'( ÓCCURRED
FELL
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This is a true and' correct reproduction of the document officially r8gistered and placed
on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS.
MARCH 19, 2009
~1-~~'
J A¡NE S. SMITH
STATE REGISTRAR
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DATE ISSUED:
This copy Is nO,t valid unless prepared on 8ngr8v8d border
displaying sta\å seal and signature of the Registrar.