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Home My WebLink About949419AFFIDAVIT OF SURVIVORSHIP STATE OF WYOMING ss. COUNTY OF LINCOLN 'GG j 12 Gwenna B. Nelson of PO Box 3005, Alpine, WY 83128, upon her oath deposes and says: 1. That MONTY HALE NELSON, the decedent mentioned in the attached copy of Certificate of Death, is the same person as MONTY NELSON named as one of the grantees in those certain Quit-Claim Deeds dated the 24th day of March, 1981, executed by Monty Nelson and Gwenna B. Nelson, husband and wife, grantors, and recorded April 2, 1981, in Book 174 PR, pages 533 and 535, respectively, of the Official Records of Lincoln County, Wyoming, covering the following described real property located in Lincoln County, Wyoming, to-wit: BEGINNING at a point N90000'E, 330 feet from the SW Corner of Section 28, T37N, R1 18W of the 6th P.M., Lincoln County, Wyoming, and running thence NO°0'E, 330 feet; thence N90°0'E, 330 feet; thence S65012'E 792 feet; thence SO°0'E, 25 feet; thence S9000'W, 990 feet to the point of beginning. ALSO: BEGINNING at a capped reinforcing bar found at the SW Corner of Lot 8 of Three Rivers Meadows Estates Subdivision "A", said point being approximately 233.73 feet North and 881.02 feet East from the SW Corner of said Section 28; thence running S75043'23"E, 50.37 feet; thence S89014'23"E, 185.23 feet to a fence; thence S68°10'50"E, 224.24 feet to a fence corner located on the East line of said SW1/4SW1/4 of Section 28; thence South along said East line 98.41 feet to a point 25.00 feet North of a Brass Cap Monument marking the SE Corner of said SW1/4SW1/4 of Section 28; thence running N66001'36"W, 483.96 feet to the point of beginning, containing 0.670 acres of land, according to the official plat thereof recorded in the County Recorder's office, State of Wyoming. EXCEPTING THEREFROM: BEGINNING at a reinforcing bar found marking a corner of the Monty Nelson Tract and a corner between Lots 5 and 6 of Three Rivers Meadows Estates Subdivision "A", said point being approximately 322.15 feet North and 333.05 feet East from the SW Corner of said Section 28; thence running N89024'50"E, 330.01 feet; thence S67009'45"E, 236.51 feet to the SE Corner of said subdivision; thence N75043'23"W, 245.60 feet; thence N10119'W, 10.18 feet; thence S89024'50"W, 308 feet; thence N0016'12"W, 30.00 feet to the point of beginning., containing 0.320 acres of land. RECEIVED 9/14/2009 at 11:25 AM RECEIVING # 949419 1 BOOK: 731 PAGE: 712 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 003713 EXCEPTING THEREFROM all lands thereof included in the following conveyances: (1) Warranty Deed dated October 21, 1991, and recorded in the office of the Lincoln County Clerk on October 23, 1991, in Book 303 PR, page 10. (2) Warranty Deed dated January 6, 1992, and recorded in the office of the Lincoln County Clerk on January 8, 1992, in Book 306 PR, page 21. (3) Grant Deed dated January 23, 2009, and recorded in the office of the Lincoln County Clerk on February 4, 2009, in Book 714, page 737. 2. That the undersigned affiant is the same identical person as Gwenna B. Nelson named as one of the grantees in the above-described Quit-Claim Deeds, that MONTY NELSON and she were husband and wife at the time of the execution and recording of the Quit-Claim Deeds described above, and that as the surviving cotenant and spouse of MONTY NELSON, named in said conveyances, the undersigned, Gwenna B. Nelson, became on September 10, 2003, the date of the death of the aforementioned decedent, the owner of the lands or the owner of any interest of MONTY NELSON, in the lands described in the foregoing, subject to any then existing liens and encumbrances. DATED as of the 2nd day of September, 2009. Gwenna B. Nelson Subscribed and sworn to by Gwenna B. Nelson before me this _ day of September, 2009. Witness my hand and official seal. My commission expi 2 F41 STATE OF WYOMING DEPARTMENT OF HEALTH 0OV 714 STATE OF WYOMING j DEPARTMENT OF HEALTH 2 o - " ? 1 } CERTIFICATE OF DEATH LOCAL FILE NUMBER. STATE FILE NUMBER TYPE 1, DECEDENT-NAME FIRST WOOLE LAST 2.: SEX 3. GATE OF DEATH (Al Oay, wJ OR PRINT PERMANENT 'Mont Hale NELSON Male September 10, 2003 BLACK SOCIAL SECURITY NUMBER Cr AG E-LId Dit)dry 50. ON R 1 YEAR ft. UNDER 1 DAY 6.0 ATE OF BIRTH (Ma. D.Y. Wj "I FOR IN ISTRUCY11ONS 82 Manw D"" ` AIp n February 26, 1921 SEE 7a PLACE OF DEATH (ChwA o* gala) HANDBOOK y~C t>QIM& ❑.bpaaent ❑:ER/OupWat ODOA Q,_*VNb,na: U'Raajdamw ❑0v_(Spadly) 7b. FACILITY NAME IN n.I k"IM alit Wr .1" And rAn't 1 I, CITY, TOWN, OR LOCATION Of DEATH. 7d. COUNTY OF DEATH 516 Nelson Lane Alpine Lincoln 8. STATE OF BIRTH (M not In USA. nwna cix ~ y) G MNPoED. NEVER MARNEO, 10. StAiVIVOlG SPg1SE (M 416,..9" tokkin noel WIDOWED, ONORCEO (SpecMy/ Wyoming Married Gwenna Buchanan 11: VAS DECEDENT EVER IN U.S ARMED FORCE37 t2a. USUAL OCCUPATION (O'M AArd a , dao dirnp mbtt 120..KIND OF BUSINESS OR INDUSTRY (SPadIY lea « rot d -*kV ft, -n Y rednd) NO P'narmacis~ Pharmaceutical 13. RESIDENCE - STATE t 3Q COUNTY tic. CITY, TOWN OR LOCATION: I3d. STREET AND NUMBER n Lincoln Alpine 516 Nelson Lane Wyomi13a. INSIDE CRY LI.BT87 11. W18 DECEDENT OF HISPANIC ORIGN7 [1 RACE-AmNlcan kd4n, 16. OECF.DElJTS ®IX.I1ION lSpatl/y Na: V ng) (SPaaBY ro a. Ye. I y+A. rpetlry Bbdt VrhlNe, Etc. (Aptidly 0* 9-* can WNadT Cupaa AANd r: Pwb fecn. Elel fSPadlyl . [0- 12 CuNpa (1-1«8+) Yes N.[9 Ya.0ISP-711 White 12 4 17. FATHER'S NAME Fint. AaOdb Lu(.::. 18. MOTHER'S NAME Fkd .,Muff Mnitlan Sur- Mariner Arnold Nelson Olive Hale 'tBa INFORMANT-Ali (T" « P,") IN. RELATIONSHIP TO. DECEDENT Gwenna Nelson Spouse. 1Be-AIAIL.IIIG ADDRESS : STREET OR RF. D. NUMBER CITY OR TOWN STATE LP CODE Box 3005; Alpine, WY 83128 ..20a Buda iCrwalbry.Rampml 20b. 1117E (AA>, Dim W.1 loc. CEME-rERY.OR CREMATORY-NAME 12 LOCATION CITY OR TOWN STATE 11 (SpadlY) . B" ia1 9/15/03 Amesville Cemetery Etna, Wyoming 2 a FUNERAL llOE Or Panm Actkv lAanbar 214 NAME OF FAG1lITV Number 21e. ADDRESS. OF. FACILITY A. 91M 426 Schwab Mortuary 45; 4 E.' 4th Av. ; Afton, WY On T. th. DM m/ . dea b and d,w 3a. of t :mY en ooarrW W tto r EI.) aV`lad- ''.///t u Ito lbw, daN anA'plaos W due b the -(al-ab*it. (Slarrbaa. and TWa/ r (Sfroo.a and )list 226 LN7E SKIAti ( DaY. n.) 22c mom OF HEATH b 23b. DATE SIGNED /Ma, Dy. V'j 23. HOUR Of DEATH 3 /J l 10:15 M M 22tl. NAME OF A HDINO Pf IAN IF OTHER THAN CERnFfER rr(pe v Pmt) S1 2W. PRONOUNCED DEAD (Aft, Dry, W..) 23s. PRONOUNCED DEAD (IIOV) !Y M 21. NAME AND ADDRESS OF CERR3ER (PHYSICIAN OR CORONERyryp « RiK) 23a RE((1 R.... - . • 125b. DATE RECEIVED BY REGISTRAR (At. Dry. 1YU PART L Ent ih dlaauaa, kiiiinaa « s IOU CRUNd daft 00 not ertnr t» nwW d dylry, wcn u <an]4c Approtbola 26. «aWkalwy amM, alwdt « hW 110- UA 0* oita oiItis ft t Nro IYdNN Bahaan OMEMn CAUSE Final iOroat and DaMh dr.aa « corldiBOtl a -Atka N bath) * N A DIME OR AS A CONSEQUENCE OF): y ( 1 I BaRONIt1A1' IM corldllorta. DUE TO NOR ASIA CONSEOIiENGE OFF I f ary.laadkq b(tnmaAats 1 oauaa Enar UNOEIILVI/lD ~ 1 cADBE.10N- I*" DUE TO (OR AS. A' CONSEQUENCE OF): I -tat 1,*W daaarlta I NwNartO In daml LAST d t FART B. OTHER SIONKRCM/T CONDITIONS-Ce dllprR conbibubf to duff Ing rot 1Eialatl b cataa gown in PART 1. 27. AUTOPSY lSpsCNy 28. WAS CASE REFERRED TO CORONER y d no (SPad/Y Yaa « rah h No No 20. MANNER OF DEATH 30a:DATE OF INJURY 30b. TIME OF 3DC KAM AT WORK? ~ 30d. DESCRIBE HOW INJURY OCCURRED Q (Moa1A NM" W, V_ ttaMTl (SPaofry Tim W11701 t. k-fti AnosIIPYaI ACCMra M a0 s. PLACE OF tN}AM(W-At 1-. farm, aO.K I.WY.' 301. LOCATION (861W and Number « Fi Rcua NuMar. City W Town. 81111100 Co ba, pl5w bWk*&we (Son VR 2-89 8 k1di ~ 11/99 15M 217645 This is a true and exact reproduction of the document on file in the office of Vital i Records Services, Cheyenne, Wyoming~u S i' Lucinda McCaffrey i DATE ISSUED: Deputy State Registrar This copy is not valid: unless prepared on paper with an engraved border displaying the date, seat and signature ofthe Deputy State Registrar. PI