HomeMy WebLinkAbout948593RECEIVED 7/28/2009 at 12:09 PM
RECEIVING # 948593
BOOK: 728 PAGE: 500
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
:a fA' 0O.
Hickman
Lnd7itleC9
I;, SINCE /BO4®
AFFIDAVIT
I, SHARLEEN BOOTH a/k/a ELLEN SHARLEEN BOOTH, being first duly sworn on
oath, depose and say:
That I am a citizen of the United States of America over the age of 21 years, and a
resident of Lincoln County.
That I was well and personally acquainted with CALVIN D. BOOTH a/k/a CALVIN
DOUGLAS BOOTH one of the Trustees of the CALVIN DOUGLAS BOOTH and ELLEN
SHARLEEN BOOTH LIVING TRUST in that certain Warranty Deed dated February 4th 2005
and recorded in Book 578, at Page 390, as Filing No. 906283, in the office of the Recorder of
Lincoln County, Wyoming.
That I know of my own knowledge that in the said deed and mentioned in the attached
Certified Copy of Certificate of Death was one and the same person.
This affidavit is intended to terminate the Trusteeship of said in said Trust in the
following described property:
BEGINNING at a point which is 12 rods North and 112 feet East, from the Southwest corner of Lot 3,
Block 24, in the Afton, Lincoln County, Wyoming, Townsite and running thence North, 33 feet; thence
East, 33 feet; thence South, 33 feet; thence West, 33 feet, to the Point of Beginning.
ALSO, BEGINNING at a point 5 rods North, of the Southwest corner of Lot 3, Block 24, in the Town of
Afton, Lincoln County, Wyoming, and running thence North, 7 rods; thence East, 115 feet; thence South,
2 rods; thence West 33 feet; thence South, 5 rods; thence West, 82 feet, to the Point of Beginning.
Tax Roll No. 3218 304 05 061.00
Dated this ,Q _ day of July! 2009 A.D.
A ~C" 2,&" OX,
Sharleen Booth a/k/a Ellen Sharleen Booth
XD6501
INDIVIDUAL ACKNOWLEDGMENT
STATE OF WYOMING
/ SS
County of 4 ,1 ca)f'~-
On the 7 -3day of July A.D. 2009 personally a
Sharleen Booth a/k/a Ellen Sharleen Booth
the signer of the within instrument, who duly ackno,
Commission expires: 3-1 ~K- ZG 12--
Residing in: AFiz nJ Wj
LANCE P. ROBINSON NOTARY PUBLIC
COUNTY OF STATE OF
LINCOLN 40 WYOMING
MYCOMMISSI1719 MARCH 1R 3012
- - - - - -
STATE OF IDAHO
,
f. DEPARTMENT OF HEALTH AND WELFARE
5 0P
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
.
CERTIFICATE OF DEATH
ad NOVEMBER 24, 2008 State File No.
2008-09406
- - LEGAL NAME
VIN DOUGLAS BOOTH
SOCIAL SECURITY NUMBER
AOE
EOF BIRTH
T
E
T
82 YEARS
:
VEMBER 15, 1926
%E
PLACE OF RESIDENCE
'
N, IDAHO
AFTON, WYOMING
TATUS AT TIME OF DEATH
NAME OF SURVIVING SPOUSE (if wile, maiden name) j /
WAS DECEDENT EVER IN
U.S. ARMED. FORCES?
RIED
ELLEN SHARLEEN LEAVITT
YES'
NAME
BIRTHPLACE
GLAS BOOTH
IDAHO
MAIDEN NAME
BIRTHPLACE
TRICE HAYES
IDAHO
F DISPOSITION
FUNERAL SERVICE LICENSEE' -
OVAL FROM STATE
CRAIG L-: GEARY
ADDRESS OF FUNERAL FACILITY
DER'S FUNERAL HOME, SHELLEY, IDAHO
DEATH
TIME OF DEATH
CITY,TOWN OR LOCATION OF DEATH
COUNTY OF DEATH
. 16, 2008
12;58 P.M. f
IDAHO FALLS, IDAHO
BONNEVILLE
)F DEATH (underlying cause last) Approx
imate Interval Between
Onset.
and Dealn.
TE RENAL FAILURE 1
WEEK
as a -sequence ot):
:.ROSCLEROTIC HEART DISEASE 30
YEAR'S
as a consequence of):
fE MYOCARDIAL INFARCTION f I
WEEK
as a consequence of):
=RLIPIDrMIA 30
YEARS
IGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not reeuiting In the underlying cause given above
WAS AN Autopsy
PEgf-0RMED?
STATED
NO
DEATH
NOME OF CERTIFIER 1
LE
-
JRAL
PATRICK D. GORMAN,tM.D.
7
SICIA
N
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
v
l
fiX ERNAL'CAUSESONLY
JURY
Tir.u, , i'IMURY
PLACEOFIMUHY
INJURY AT
WORK?
I
WHERE INJURY OCCURRED
ON OF HOW INJURY OCCURRED
gDED 12/18/2008
AAgtT This is a true and correct reproduction of the document officially registered and placed
A
tt
on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
~rc~m""`~AAAgAti 1
_
.
y)Rh
FEBRUARY 10, 2009
DATE ISSUED:
is not valid unless prepared engraved border JANE S. SMITH
st displaying
state seal and signature of Registrar, STATE REGISTRAR
~
-
F 'L4
. •
'
,