HomeMy WebLinkAbout948561coodwy
State of Wyoming
County of Lincoln
RECEIVED 7/27/2009 at 1:37 PM
RECEIVING # 948561
BOOK: 728 PAGE: 369
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT TERMINATING ESTATE BY
JOINT TENANCY
I, Coralie Am haner, being of lawful age and first duly sworn according to law, upon
my oath, depose and statd:
That Cora Loomi~, died on May 13, 2009 in Ogden, Utah.
2. That on July 21, 1993 for valuable consideration W.F. Loomis and Cora Loomis,
husband and wife by their QuitClaim Deed of that date, which deed was duly filed
for record in the Office of the Lincoln County Cleric on July 22, 1993 in Book
332PR on page 338, conveyed unto W.F. Loomis and Cora Loomis, husband and
wife as tenants by the entireties and Gregory Ellis Shaner and Coralie Annp''~
Shaner, husband and wife as tenants by the entireties, as joint tenants with full
rights of survivorship, the folling described really property:
Lot 310 of Lakeview Estates Incorporated, Tracts A-F, Lincoln County,
Wyoming as described on the official plat filed January 5, 1965 as
Instrument No. 386448 of the records of the Lincoln County Clerk.
3. That by reason of the`said conveyance, W.F. Loomis, Cora Loomis, Gregory Ellis
Shaner and Coralie Ai~Shaner, became the owners of the real property as joint
tenants with full rights of survivorship and title thereto vested in them
continuously fror4 said date of conveyance as described in said QuitClaim Deed,
until the date of death of Cora Loomis on May 13, 2009 at which time to the
above described real property vested absolutely in Gregory Ellis Shaner and
Coralie Amy Shaner, husband and wife as tenants by the entireties in accordance
with the provisions of §2-9-102, W.S. (1980).
4. Affiance avers and certifies that deceased is the identical party names with
Affiance in the aforementioned deed whose death terminated her interest, title and
estate in th said real property; and Affiance attached 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 27 day of July, 2009
State of Wyoming
County of Lincoln
Coralie Ann Shaner
The foregoing instrument was subscribed and sworn before me by Coraliee Anne
Shaner this 27, day of July, 2009
Witness my hand and official seal.
Notary Public
My Commission Expires: August 10, 2011 Courtney F'S b n N c,public
COlJnly of d
Lincoln 1 t5} State of
Ktl 3'p K~ -rninng
MY ComiNe-..-pissi~-isres
St -
ate File Number: 20090181.38 r
Cora Loomis
DECEDENT INFORMATION
,
Date of Death: \ May 13, 2009 Time of Death: 23440.
City of Death: Ogden. County of Death: Weber
Age: 89 `Date of Birth: August 12 191.9
Place of Birth: Johnstown, Pennsylvania Sex: Female,
Armed Services: No' Marital Status:: ,-Widowed
Spouse's Name: Usual. Occupation: Homemaker.
Industry/Business: Own Home 'Education: •.,Some College but.,No Degree
Residence: Ogden Utah ,4,8tttrer's Name: _ Nicholas Buchan
Mothers Name. Mile Ribich B ffs ~a>✓Illf 'y0e vp Home
ia1 ` ~r V
Facility or Address:l 945 East 550,
` ft Fa 'K r1t Ar z "'4/0
INFORMANT INFORMATION
Name: CoPalJe Shane, x 6Y Axitrb `~~~~~~~atibrl>;hip ~ Dau~N~i3
r
z t'^• 5R v s' Wrrst~;~'a
Mailing Address: 1304: .Lookwood Driv Lafayette; Indiana 4794 s
4
DISPOSITION. .INFORMAtjb i y 5 o f 3lks n
Method of Disposition u ~ -~rematidn,ik. hs f f ~fyp~,~i'Ps' ~ • 4a~i °~+'a'~ t , ~r, :~i~ ~ l ~ ti
Place of Disposition i £2° Leavitt's GematoryiOg~eny;tltdJE~'twt s~'ttl4i''t';iaa
Date of~bisposition s4, May,17,Y.b09rk4 Y;'7rr'sA~
FUJ>IERAL HOME IN i6POW fio0 A
Th. A
Funeral Home: Leavitt Mort u4 r; H r f r
:s 1ha ' ~aS r 3 i b
Address: : 1,836 6th Str64t. a clke f Utah 844b M~ . '
Funeral Director Mike Leavlttl
1 { 4 -,x Ili Rx,w~a (r lit >_`}sP,~; t R of .
MEDICAL CER`I'IFICAI`ION;i r~'1 E /t"~ ~ n .t sA?
to a 1-
Medical Professional" Nam er T. Qad'& Mbr1519M 5qyF6'4 >s~ $te O g
~t [Jtah 84401 '
i s f'tt rw:~ Z 7fi« a 'Ft s~. a 'js }:J ytpl` r ~sSiTcf-'3 s`~,+ _
t : ' ` • 1~~~ 474i~t~ frr~Y~~~13`"~ `'g ~ ~S~Mf ~ 8 4s~ sA u
CAUSE OF DEATH til.:; t 7 f 'Yf 6~ \
erebral vascular accident [Onset 5 Yeats) NJ~,"~ rJ t/ s of p
-fib [Onset: 5 Yearsj r¢~'ry' t f t2'~~4} lE 1"11 k}V x `fig n
Hypertension [Onset. 5Y"W~ars]{ '-,I) y ° 9 idr 2 @ is } v~ s t i? P t
, ~ 7 tr,t1 n
Tobacco Use: Unknowiti if Llstst
Medical. Examiner Contacted-! 'es sAdt<opsy 1is performed: o Manner of Death ,f~flat' .1p
yral
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i f I ra I s
5f ~T,I:rr " Lnt ~t
Date Issued: May 18,:2009, ~ r a 7~",Xd e,t t ~
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This Is an exact reproduction 'of the docul lent registered In the State Office of Vital Statlaticsr
Security features of; this official docUrnent,inciude: intaglio Sorder; V & R trgagesIn top.cyclolds,
ultra vlolet.fibers;:and hologram Image of the Utah State Seal, over the words "State of Utah This
document,displays'the date, seal and signature of the State Registrar and the County/b strlot.fiealth Officer.
-
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*08;203970 ouse....
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Bar E. Nan Isle State istrar Director/Health Officer
Offi a of Vital Statistics' 9 County/District Health Department. .