HomeMy WebLinkAbout951614RECEIVED 1/14/2010 at 10:02 AM
RECEIVING 951614
BOOK: 740 PAGE: 123
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY Affidavit of Survivorship
I, Elmer E. Nelson, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date of November 26, 1991, for valuable consideration, Haroldine Faye
Smith and Lois June Mackay, by deed of that date, which deed was duly filed of record in the
Office of the Lincoln County Clerk, on December 5, 1991, in Book 3o4PR, Page 604, conveyed to
Elmer E. Nelson and Gertrude M. Nelson, husband and wife, as tenants by the entireties the
following described land, to -wit:
The Lot Numbered Seven (7) of the Block Numbered Forty-three (43) of the First Addition to the
City of Kemmerer, as the same appears of record on the map and plats now on file in the Office of
the County Clerk and Ex- Officio Register of Deeds in and for said County of Lincoln, in the State
of Wyoming, together with all buildings, improvements and appurtenances thereon situate or in
anywise appertaining thereto
That by reason of said conveyance aforesaid, the said Elmer E. Nelson and Gertrude M.
Nelson, 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 Gertrude M. Nelson
on the 13th day of July, 2009. That by reason of and upon the death of Gertrude M. Nelson, also
known as Gertrude Margaret Nelson, title to the above described real property vested in Elmer E.
Nelson.
Dated this day of gJAULAA29, 2010.
State of (-011 -:Cp-
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County of U11-10....0-1-t-
WITNESS my hand and official seal.
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Affiant avers and certifies that Gertrude Margaret Nelson is the identical party named
with Elmer E. Nelson 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 matter of record.
Elmer E. Nelson
Subscribed and sworn to before me, a notary public in and for said County and State, by
Elmer E. Nelson, this I 1 day ofc14-1.-Lizati 2010.
Notary Public
This Documsnt is Whip recorded by
Rocky Mountain Title 1
of LIinColn County Mi CQQI, i Y cnIy
CERTIFICATIO ITAL RECORD
DECEDENT INFORMATION
Date of Death: July 13, 2009
of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry /Business:
Residence:
Mother's Name:
Facility or Address:
INFORMANT INFORMATION
Name: Barbara Smith Relationship:
Mailing. Address: 1523 Van Buren Circle, Salt Lake City, Utah 84104
DISPOSITION INFORMATION
Method of Disposition: Cremation. r
Place/of Disposition: Utah Funeral Directors Cremation Center, South Jordan /Utah
Date. of Disposition: July 18, 2009'
FUNERAL HOME INFORMATION
Funeral Home: SereniCare Funeral Home, 'LLC
Address: 12278 South' Lone Peak Parkway, Suite #103, Draper, Utah 84020
Funeral Director: J' Heath Holverson
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Murray
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Murphy Township, Minnesota
No
Elmer E Nelson
Nursing Home
Kemmerer, Wyoming
Anna Catharina Elise Vagts
Intermountain Medical Center.
MEDICAL CERTIFICATION
Medical Professional: Douglas Noland Smith MD, Intermountain Hospice, 2250 South 1300 West, Salt Lake City, Utah
CAUSE OF DEATH
Aspiration pneumonia
Renal insufficiency
Diabetes type 2
Aortic valve disease
Tobacco Use: Non -user
Medical Examiner Contacted: Yes Atopsy Perform ed: No
This is an exact reproduction' of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V R images in top cycloids,
ultra violet fibers and hologram image of the Utah State Seal, over the words "State of Utah This
document displays the date, seal and signature of (he State. Registrar and the County /District Health Officer.
Barry E. Nangle, State Registrar
Office of Vital Statistics
CERTIFICATE OF/DEATH
State File Number: 2009020562
Gertrude Margaret Nelson 000124
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
Mahner of Death: Natural
04 :45
Salt Lake:,
August 25, 1924
Female
Married
Dietary Supervisor
9th Through 12th Grade
Oscar F Johnson
Hospital Inpatient
Daughter
V
Gar .'Edwards
Director/Health Officer
County /District Health Department