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Affidavit of Survivorship
I, Harold L. Kellogg, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under th.e date of November 30, 2006, for valuable consideration, Harold L. Kellogg,
by deed of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk,
on November 30, 2006, in Book 641, Page 748, conveyed to :Harold L. Kellogg and Yvonne M.
Kellogg; husband and wife, the following described land, to-wit:
Parcel 1
That part of the NE1/4NE1/4 of Section 7, Township 26 North Range 112 West within the
incorporated limits of the Town of LaBarge, Lincoln County, Wyoming described as follows:
BEGINNING at a point on the South line of the said NE1/4NE1/4„ South 89°58' West, 1073-64
feet from the Southeast corner of said NE1/4NE1/4 where found 2 inch galvanized steel pipe with
brass cap inscribed "PAUL N. SCHERBEL RLS 164 BIG PINEY, WYOMING, T26NR112WN1/16
S7/S8 1977" and North 89°58' East, 1563.25 feet from the Southwest corner of the NE1/4NE1/4 of
said Section 7 where found a granite stone 10"x17"x6" marked 1/16 on W, SS on E;
thence North 89°58' East, 100.0 feet to a point;
thence North 00°14' East, 50.0 feet parallel to the East right-of-way line of State Highway 189 to a
point;
thence South 89°58' West, 100.0 feet parallel to the said South line to a point;
thence South 00°14' West, parallel to the said right-of-way line, the base bearing for this survey,
50.0 feet to the point of beginning.
each point marked with steel T-shaped stake 24" long with metal cap inscribed "SURVEY POINT
DO NOT DISTURB RLS164".
Parcel 2
That part of Lot 3 of Section 7, Township 26 North Range 112 West of the 6th P.M., Lincoln
County, Wyoming described as follows:
BEGINNING at a point on the North line of the said Lot 3, South 89°58' West, 1073.64 feet from
the Northeast corner of said Lot 3 where found a 2" galvanized steel pipe with brass cap inscribed
"PAUL N. SCHERBEL RLS 164 BIG PINEY, WYOMING, T26NR112WN1/16 S7/S8 1977" and
North 89°58' East, 1563.25 feet from the Southwest corner of the NIA of said Section 7
where found a granite stone 1onx17"x6" marked 1/16 on W, SS on E;
thence North 89°58' East, 100.0 feet to a point;
thence South 00°14 West, 50.0 feet parallel to the East right-of-way of State Highway 189 to a
point;
thence South 89°58' West, 100.0 feet parallel to said North line to a point;
thence North 00°14' East, parallel to the said right-of-way line, the base bearing for this survey,
50.0 feet to the point of beginning.
each point marked with steel T-shaped stake 24" long with metal cap inscribed "SURVEY POINT
DO NOT DISTURB RI.S
Parcel 3
A parcel of land located in a portion of the NE1/4NE1/4 of Section 7, Township 26 North Range
112 West of the 6th P.M., Lincoln County, Wyoming within the incorporated limits of the Town of
LaBarge, being more particularly described as follows:
Commencing at a point 011 the South line of the said NE1/4NE1/4, South 89°53' West, 1073.64
feet from the Southeast corner of said NE1/4NE1/4 where found a 2 Ina galvanized steel pipe
with brass cap inscribed "PAUL N. SCHERBEL RLS 164 BIG PINEY, WYOMING,
T26NR112WN. 1/16 S7/S8 1977", said point identical with the Southwest corner of a tract of land
recorded in the Office of the Clerk of Lincoln County in Book t39PR on page 293;
RETURN TO
DRI Title gi Escrow
12720 T Street, Suite 100
Oindha, 68137
RECEIVED 11/20/2009 at 3:10 PM
RECEIVING 950689
BOOK: 736 PAGE: 456
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
thence North 00°14' East, 5o,00 feet parallel to the East right-of-way line of State Highway 189
and along the West line of said tract of record in Book 139PR to the Northwest corner of said tract
of record in Book 139PR, said Northwest corner being the point of beginning of this described
parcel, said point of beginning also being the point of beginning of Parcel #2 recorded in the
Office of the Clerk of Lincoln County in Book 213PR on page 658, also being a steel T-shaped
stake;
thence continuing- No0°14'00" East, parallel to the said East right-of-way a distance of 51.30 feet
to a 5/8" rebar with aluminum SU stamped "JFC PELS 574";
thence North 89°47'16" East, a distance of 100.24 feet to a 5/8" rebar with aluminum SURV-KAP
stamped "JFC PELS 574";
thence South 00°13'22" West, a distance of 51.02 feet, to a steel T-shaped stake with a metal cap
inscribed "SURVEY POINT DO NOT DISTURB RLS 164", and being the Northeast corner of said
tract of record in Book 139PR;
thence South 89°37'40" West, along the North line of said tract of record in Book 139PR., a
distance of 100.25 feet to the point of beginning of said parcel.
That by reason of said conveyance aforesaid, the said Harold L. Kellogg and Yvonne M.
Kellogg, husband and wife, became the owners of said real property, and title thereto vested in
them continuously from the date of said conveyance, to the date of death of Yvonne M. Kellogg on
the lith day of .April, 2008. That by reason of and upon the death of Yvonne M. Kellogg, title to
the above described real property vested in Harold L. Kellogg.
Affiant avers and certifies that Yvonne M. Kellogg is the identical party named with
Harold L. Kellogg in the aforementioned deed, whose death terminated. her interest, title and
estate in said real property; and Affiant attaches hereto and makes a part of this affidavit, a copy
of the Official Certificate of Death of said decedent, duly certified by the public authority in which
said death certificate is a patter of record,.
Dated this g day of WO Uetvlie6(709.
CiSIQ
Haro4.1.ellogg
State of Wyoming
County of Lincoln
My Commission. Expires:
s
Subscribed an to to befairei me, a not public in and for said County and State, by
Harold L. Kellogg, this day of NO ue-m Dar 2009.
WITNESS my hand and official seal.
4
PAMELA K. TIEMANN
Notary Public
Sweetwater County
Wyoming
My Commission Expires 1
Wyoming
L1
11M la/ la, 4
Death Certificate for Yvonne M. Kellogg
*Do not detach
For Recording Purposes Only
RETURN TO
DR! Title Escrow
12720 I Street, Suite 100
Omaha, NE 68137
{o 4 58
Mao
6 1 r
VtiATI» T
44 CERTIFICATION OF VITAL RECORD L:
STATE DPARTMENt 23F HEALTH
DEATH CERTIFICATE
Decedent: State File Number: 2008-001330
Name: Yvonne M Kellogg
Gender: .Female Social Security Number:
Date of Birth: April 25, 1927 Age at the Time of Death: 80 years
Date and Place of Death:
Date of Death April 11, 2008 Actual County of Death Teton
City of Death: Jackson
Location: Inpatient St. Johns Hospital PO Box 428
Additional Decedent•inforniation:
Place of Birth: Unknown, MissOuri
Residence: La Barge, Wyoming
Marital Status: Married Name of Surviving Spouse: Harold Kellogg
Armed .Forces: NO
Name of Father: Unknown Vincent
Maiden Name of Mother: Unknown Unknown
Informant. Harold Kellogg Relationship: Husband
Disposition:
Method of Disposition Creniatiori
Place of Disposition: Valley Mortuary Crematory, Jackson, Wyoming
Funeral Home or Facility:
Facility: Valley Mortuary, Jackson, Wyoming
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes. Interval:
(a) Respiratory Arrest Mins
(b) Chronic Obstructive Airways Disease Years
Other Significant Conditions: Interstitial Lung Disease (Boop)
Manner of Death: Natural Death Time of Death: 10:36 Actual
Certifier:
Name: Dennis L Butcher, M.D.
Address: P. 0. Box 3009, Jackson, Wyoming
Date Filed: April 19, 2008
3 7 7 0 5
This is a true certification of the document on file in the office of Vital
Records Services, Cheyenne, Wyoming.
SATE May 19,
0
C" This copy is iva1id unless prepared on paper with an engraved border.
()459
Gladys K. Breeden
Deputy State Registrar
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