HomeMy WebLinkAbout947431THE STATE OF WYOMING )
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THE COUNTY OF LINCOLN )
AFFIDAVIT TERMINATING ESTATE BY •s 13,
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JOINT TENANCY
Tammy E. Mai being of lawful age and first duly sworn according to law, upon my oath,
depose and state:
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1. That Les G. Mai died on September 6, 2007 in Salt Lake City, Utah.
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2. That on February 28, 1995 for valuable consideration Leisure Valley, Inc. by their
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Warranty Deed of that date, which deed was duly filed for record in the office of the Lincoln
County Clerk on March 21, 1995 in Book 366PR on page 218, conveyed unto Tammy E. Mai and
Les G. Mai, as joint tenants with full rights of survivorship, the following described real property, to
wit:
Lot 101 of the Star Valley Ranch Plat 17, Lincoln County, Wyoming as described on the
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3. That by reason of the said conveyance, Tammy E. Mai and Les G. Mai became the
owners of the real property as joint tenants and title thereto vested in them continuously from said
date of conveyance as described in said Warranty Deed, until the date of death of Les G. Mai on
September 6, 2007 at which time title to the above described real property vested absolutely in
Tammy E. Mai in accordance with the provisions of §2-9-102, W.S. (1980).
4. Affiant avers and certifies that deceased is the identical party named with Affiant in
the aforementioned deed whose death terminated his interest, title and estate in the said real
property; and Affiant attaches hereto and makes a part of this Affidavit a copy of the official
certificate of death of decedent, duly certified by the public authority in which said death certificate
is a matter of record.
Dated this / of M Au 2004
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State of Idah.
County of 11 A ft-i
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The foregoing instrument was subscribed and swom to me by Tammy E. Mai this -I- day
of L"T\ a U 12009.
Witness my hand and official seal,
Not ry Publi~
My Commission Expires:
RECEIVED 5/28/2009 at 4:03 PM
RECEIVING # 947431
BOOK: 724 PAGE: 134
JEANNE WAGNER
BETTY VASQUEZ
NOTARY PUBLIC
STATE OF IDAHO
LINCOLN COUNTY CLERK, KEMMERER, WY
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THIS INDENTunE, matte, this all, day of Pehruarv ,10_25,
by and between LEISURE VALLEY, INC.,e Corporolion organited and existing under
and by virtue of the laws of the State of NEVADA, duly aulhol9ted to do business in the
State of WYOMING and having its principal place of business In the County of Lincobi,
Stale of Wyoming, the GRANTOR, and
T.-Y li. Mal And Les G. Mai as loiw TeumHs
of the County of Bannock: -,State of _ld.d,n
the GRANTEE, whom address is 2239 31"melton
WITNESSETH: Thot the GRANTOR, for and in consideration of TEN DOLLARS
($10.00) in hand paid, the receipt whereof is hereby acknowledged, does, by these pres-
ents, grant, bargain, sell, CONVEY AND WARRANT unto thesaid GRANTEE, all that
certain tract, lot, piccc, and parcel of land situate In the County of Lincoln. State or
Wyoming, hereby releasing and waiving all rights under and by virtue of thehomestCAd
exemption laws of the State, to-wit:
STAR VALLEY RANCH PLAT SEVENTEEN (17) LOT ONE-HUNDRED ONE. (101) as
platted and recorded in the Official Itecords of Lincohs County, WyouUng.
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RESERVINO THEREFROM all rights, title, and interest in and to any and
ail minerals and rights appertaining thereto.
Subject to all declarations of covenanls, conditions and resrictions of record.
IN WITNESS WHEREOF, the Grantor has caused itscorporate seal to be hereunto
affixed, and these presents to be signed uy its duly aulhuriaed agent, Ilie (lay and year
first above written.
jSEAL)
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STATE Or Nevado ~n
COUNTY Of C1.912
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LEISURE VALLEY, INC.
A Ntvl/stde-,C,Enrrdiioo.
BY ~tL-A..~(Ptlt+wZ--
Au,a.m.d AA
The foregoing Inetn:mew was acknuwladgud ladoru me by
authod"d agent of L.aiaure Vulley, Ine.. a Nuvadn turlaou: ion:
this 21 rh day el Febniary__, 19__2.1
Witness my hand and ofieial wa1.
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CERTIFICATE OF DEATH
State File Number: 200700985311,3
Leslie Gene Mai
DECEDENT INFORMATION /
Date of Death: September 6, 2007 Time of Death: 0$:05
City of Death: Salt Lake City County of Death: Salt Lake
Age; 61 Date of Birth: January 3, 1946
Place of Birth: Twin. Falls, Idaho Sex: Male L
Armed Services: No Marital Status: Married
Spouse's Name: Tammy Esther Harris Usual Occupation: Owner/Operator
Industry/Business: Vehicle Maintenance Education: Some College but No Degree.
Residence: Pocatello, Idaho Father's Name: Benjamin Franklin Mai
Mother's Name: Helen Mae Bean Facility Type: Hospital Inpatient
\ Facility or Address; LDS Hospital
INFORMANT INFORMATION;
Name: Tammy Mai Relationship: Wife
Mailing Address: 3648 Summit Drive, Pocatello, Idaho 83201
DISPOSITION INFORMATION /
Method of Disposition: Burial/Removal Date of Disposition: September 11, 2007
Place of Disposition: Mountain,View Cemetery, Pocatello, Idaho
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FUNERAL HOME INFORMATION \
Funeral Home: Goff Mortuary
Addrress 80 0 South State, Midvale, Utah 84047
Funeral Director: ,Del Ballard:,.
MEDICAL CERTIFICATION
Certifying Physician: Clyde D Ford MD, 8th Avenue &,C Street; E-8, .Salt Lake City, Utah 84143 )
CAUSE OF DEATH
Acute Myelogenous Leukemia [Onset: 6 Weeksj `
Tobacco Use: '.Did not Contribute -
Medical Examiner Contacted: No Autopsy Performed: No -Manner of.Death; Natural
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BATE ISSUED: September 7, 2007
This is an exact reproduction of the document"registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V & R images. in top cycloids,
ultra violet fibers and hologram image of a hawk over the word valid. This document displays the
date, seal and signature of the State Registrar and the County/District Health Officer.
44, ~Pti OF THE Updated Utah State Seal replaces hawk over valid for authenticity.
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L ,~Pay~ y E. Nangle, Sta0te Registrar ,c O 6 1 2 8 6 6 5 7 * Director/Health Officer It -Lake valley a,n Depart¢~r
1 i Office of Vital Statistics County/District Health Department I,,ri'' J
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