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Home My WebLink About948955AFFIDAVIT - ESTATE BY ENTIRETIES STATE OF WYOMING ) C"00072 ) SS COUNTY OF LINCOLN ) Gwen Nelson, first duly sworn, upon oath, deposes and says: 1. Fay D. Nelson and Gwen Nelson were married to each other at Idaho Falls, Idaho on December 17, 1951 and they lived together as husband and wife for many years and continuously until the death of Fay D. Nelson. 2. On March 19, 1957, Lloyd Hyde and Glenda Hyde conveyed by Warranty Deed to Fay D. Nelson and Gwen Nelson, husband and wife, the real estate described as follows: Beginning at the Southeast Corner of the NW1/4SW1/4 of Section Four (4), Township 32 North, Range 119 West of the 6th P.M., Wyoming and running thence West 55 rods, thence North 25 rods, thence West 25 rods, thence North 31 rods, thence East 80 rods, thence South 56 rods to the place of beginning. The Warranty Deed was recorded in the office of the Lincoln County, Wyoming, Clerk and Recorder in Book 134PR, Page 604 and thereafter Fay D. Nelson and Gwen Nelson, husband and wife, became owners of the property by an estate by entireties. 3. On October 27, 1980, Lloyd Hyde and Glenda Hyde conveyed by Warranty Deed to Fay D. Nelson and Gwen Nelson, husband and wife, the real estate described as follows: Lot 4, Block 15, in the Townsite of Auburn, Lincoln County, Wyoming. The Warranty Deed was recorded in the office of the Lincoln County, Wyoming, Clerk and Recorder in Book 169PR, Page 645 and thereafter Fay D. Nelson and Gwen Nelson, husband and wife, became owners of the property by an estate by entireties. 4. On January 15, 1968, Lloyd Hyde and Glenda Hyde conveyed by Warranty Deed to Fay D. Nelson and Gwen H. Nelson, husband and wife, the real estate described as follows: Commencing at a point 80 rods North of the SE Corner of Section 5, T. 32 N., R. 119 West of the 6th P.M., Wyoming, thence West 80 rods, thence North 56 rods, thence East 80 Rods, thence South 56 rods to the place of beginning, containing 28 acres, more or less, with improvements and water-rights. The Warranty Deed was recorded in the office of the Lincoln County, Wyoming, Clerk and Recorder in Book 81 PR, Page 452 and thereafter Fay D. Nelson and Gwen Nelson, husband and wife, became owners of the property by an estate by entireties. 4. Fay D. Nelson died on December 27, 2003. Attached is a copy of his official Death Certificate certified to by the Vital Records Services, Division of Health and Medical Services, Wyoming Department of Health and Social Services, the public authority with which the original Death Certificate is of record according to law. RECEIVED 8/17/2009 at 12:51 PM RECEIVING # 948955 BOOK: 730 PAGE: 72 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY X0`0'73 5. By reason of the death of Fay D. Nelson, Gwen Nelson became the sole owner of the above-described real estate interests on December 27, 2003. Gwen Nelson 5~. The foregoing instrument was acknowledged before me by Gwen Nelson, this day of July, 2009. Witness my hand and official seal. My commission expires: "2,0 C'~Ln DE K. IZATT - NOTARY PUBLIC f }j N State of S ~Wyomin g 'm-:: 3 mmission Explrms Ootobo;r 0, 9011 STATE OF WYOMING D.EPARTMENT OF HEALTH . ®CY° 7 STATE OF WYOMING DEPARTMENT OF HEALTH n LOCAL FaE NUMBER CERTIMCATE OF. MAN nn .t.!_ •.9 `14 TYPE - " STATE FILE NUMBER ` PRINT ORYPE 1. DECEDENT-NAME FIRST MIDDLE LAST 2. SEX a.DATEOF DEATH (AF., D•I. »J IN PE BLACK ;FAY _ DANA NELSON ...MALE DECEMBER .27, 2.003.: 1 1. 90CfILL SECURITY NUMBER 11a,fAaE-Up Bk*.My 64 1 - : T V 9. DATE lN: BRTN OM »J . fA.rAlje Oqa II.IR. MIMH INStTRt1CT10Ng 80 JANUARY 15, 1923 SEE HANpgppK 7a PLACE OF DEATH (clI*& pMy al.l . :H!?'J®L QlnptNnt ❑'.tA10"I-t 006A d:"urkMd Fti1W Cla.1M¢I op.r (SP.dMYI 7b. N1C0.1TY:NAME.fN rqf MtlbMtiL air. •b..( aq n1.nbAJ 7a CrrY';.TOWN OR L.OCIITION OF DEATH d. COUNTY OF DEATH #14 - 402 CEMETERY ROAD AUBURN LINCOLN B. STATE OF BIRTH Is nd 0 USA.. nnl. c.1.I.Y! B. MWIIEIX NEVER MARRIED. 10. SURVIVING SPOUSE fit Wk ON. -b. r 1 WIDOINED, WYOMING :;MAR appflcED A1tR ID GWEN NYDE 1 f. VDECEDENT-EVER IN UJA ARMED FORCES? 2_., t/NI.000UFR7ION lGh~ A.M 11E::wak darN,dV.Rl•1r1PN 120. KIND OF BUSINESS OR INDUSTRY . (;:C Y►.'a n.l or wkha k~. -w.n N ndllNl YES" MECHANIC FARM EQUIPMENT I a.. RESIDENCE -STATE lab. COUNT lac. CRT'. TOWN.OR.LOCATIOPI:. 1:1E- STREET. AND NUMBER : WYOMING LINCOLN AUBURN #14 --,,402 ,,CEMETERY: ROAD 13k. INSIDE CT' ! M rK . a m1 / 11. ISP.eIY n. A'AAB DECEOE Y.. Y....P. OR OW 18. Am Ind4n, a - _am.", ,VAII.. EN. If. DL'CFD .S EDUCATION, NO OA.N Nalco. P11.rb Rb.lt Etal, :(4-dry ab hw" P.M c.1rONNd1 y W14~~E E%- 1S..a dwy .10-t Coll.w n-I a E*) . N. C:) V.. ~fBP.a1F'1 `4 1..0'. 17. FATHERS NAME FI.1 MbW. ::la.l. vs: MOTHER. NAME F f Aaadl.. M.W. S1..." ANDREW JENNINGS NELSON LUCY ANN DANA faa aPORMAM-NAME (Tp. a RMt) 19b. REIIITgN 1 TO DECEDENT GWEN:NELSON SPOUSE lac. MAILMO ADDRESS . STREET OR A.F.D. NUMBER CITY OR TOWN STATE LP CODE P. 0. BOX 643 AFTON WYOMING 83110 ` 2W. &.%t O.nl.ll.n; R.111a.1 20b. DATE (Aft. OW, »J ham YDC CEMETERY OR 8 Ma-OY1N 'CIEM1170M-NMIE 20d..lDGTION CITY OR :TOWN $U17fi„ (SPeepYl'.' BURIAL I` DEC.. 30, 20:03 AUBURN CEMETERY AUBURN. WYOMING B • ZiaeE EE d Pst..n Rama Numbs YID. KAMEOF FACILITY 8.M ( Nl.nb.r t lc. ADDfl689 OF FACILITY SCHWAB MORTUARY/ 45 44 EAST FOURTH-AVE., AFTON 22. 'a Ih6 n P.:rq tlIiaii a AIiM , aoMI n a ft ll. tw. We ~Istea . .eamM M the 1N,., MM .110 al.c. Md~Aw.b iM pd..(.1 .bbd. °I' (S1p1.eAi~ a+d ?Nbl MW. dwith OTg$1 YT4 RATE SniYC'1 (Ab., 22C HOUR OF DEATH O pJb DATE SIGNED /MU. D.Y. »J lac HOUR OF DEATH Y7d` OF o M M E . NAR ME OF ATTENDING YSICUN IF.071/En. THAN CERr»TER m- a r s" $ 23d PRONOUNCED D EAU (Aft,. D.,. »J " 23.: FRONOUNCED OEAD_fH-) . 2/. NAME AND AODRE88 OF CERTIFIER (PHYSICIAN OR COnGHERIlTh~. a PM1.) 0. D., PERKES MD. 110 HOSPITAL LANE :AFTON, WYOMING::83110 26a REG18TR11R 126b. DATE RECEIVED BY REGISTRAR fAin, B.1'. r) RUT L E~ th. dl-. 2B Ir(udq a 1wnclka art ou..tl d..IR D. roI rAlr rb .mde of d7kp, .YCn p craoc may„ . a -01-Y -K stlodc a h d I.Y - List 1.., 11f+ talw..n ..stl IMr. ' IMMEDIATE-CAUSE IFkw IO1WR and OMPL.. db- arbaldal.n nOAkgNdwbf'» a C J 1~ 111 9`I) fC Ir° 9t' r 1 1Ur1 Aa w~ONBEOtA'NCE OFI, / ' 1 I b c.vh,~....G.. U If 1D;.:.. t B.v1~11bIY NM c.I1dKl.r1.. DUE 70IGIi AS A CONSEQUENCE OFJ; 1 N stiY. b.dNY b I1M1Mdflb. 1 auea El NIDatKWNB:. a 2. CAUSE IDb.1u. a k*A DUE TO (OR A CONSEQUENCE OF)': 111.1 INY.I.d ...Ib I r..1Alrq N d..a11 LAST 1 RUT a. OTHER SIGNIFICANT CONDITIONB.C.ndl11.11. obwblbll.la b 4.tl1 but rwt nWled:b c ubj p1w11 N PART I. T. A fdp.cp, RB. VMB CASE REFERRED 70 CORONER 7.. a nP (Sp.dfF M a m/ NO NO ` n O 20. MNINER OF DEATH 30a DATE OF lUIpW fAA. a0b TNIE OF a0e INNRY AT WORK? 30d. DESCRIBE (IOW NUIp1Y OCCURRED Dp, nrl auuRY IKAW Mk WORK? . Nays nNleieo _ JPN D VR 2-89 8 ' 30.. ~E OF INJURY-AI 11.111., brio, .b..4 f.ewy. _ MI. LOCATION 18&.0 .0 N.~ a Ra.l Rwb Nue r. CRT a Tow.. a j . ~D~--I,,In.dM balrv...c fBP.cpvl 11/99 15M H. AH.. ~llll This is a true and exact reproduction of the document on file in the office of Vital - Records Services, Cheyenne, Wyoming. DATE ISSUED: JA Lucinda McCaffrey Deputy State Registrar This-copy is not valid unless prepared on paper with an engraved border displaying the date seal and signature of the Deputy State Registrar. ~l