HomeMy WebLinkAbout952952WHEN RECORDED, MAIL TO:
SCOTT AWERKAMP, ESQ.
SNOW, CHRISTENSEN MARTINEAU
555 South Bluff Street, Suite 301
St. George, UT 84770
MAIL TAX NOTICE TO:
Dianne Cleaver
91 North 3910 West
Hurricane, UT 84737
STATE OF UTAH
COUNTY OF WASHINGTON
)ss.
RECEIVED 4/16/2010 at 10:24 AM
RECEIVING 952952
BOOK: 745 PAGE: 569
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVING JOINT TENANT
RE: DEATH OF JOINT TENANT
eeO• 569
DIANNE CLEAVER, affiant, and surviving joint tenant, of legal age, being first duly sworn,
declares as follows:
That JOHN PALMER CLEAVER, the decedent mentioned in the attached certified copy of
Certificate of Death, who died on January 31, 2010, is the same person as JOHN P. CLEAVER,
named as one of the parties in that certain Warranty Deed dated July 10, 2008, executed by
Gerald E. Hudson and Peggy K. Hudson to JOHN P. CLEAVER and DIANNE CLEAVER, husband
and wife, recorded as Document number 940761 on July 23, 2008, in Book 700 Page 672, of the
Official Records of Lincoln County, Wyoming, covering the following described properties
situated in Lincoln County, Wyoming:
Star Valley Ranch RV Park Plat No. 1, Lot No. 437, as platted and recorded in the
official records of Lincoln County, Wyoming, together with all buildings,
improvements and appertaining thereon situate or in anywise appertaining thereto
Subject to any easements, reservations, restrictions or right -of -ways of record, or
sight or in use.
At the time John P. Cleaver and Dianne Cleaver acquired the above property, they were
husband and wife, and since that time they have continued as husband and wife until the death of
John P. Cleaver. Fee simple ownership is now vested in Dianne Cleaver.
Dated: 3 l v
SUBSCRIBED AND SWORN to before me this Z day of March, 2010.
NOTARY PUBLIC
DIANNE CLEAVER, Affiant
2
A
Notary Public Stale of Utah
Coma bp,: Moy 9,, 2010
C Number• 564334
O kr 57O
CERTIFICATI t ITAL
L RECORD
DECEDENTINFORMATION
Date of Death: January 31, 2010
City of Death:
Age:
Place of Birth:
Armed Services:
Spoy+se's Name:
IndUstry/Business:
Residence:
Mother's Name:
Facility or Address:
Date Issued`.. February 4, 2010
Hurricane
82
Somerset, Pennsylvania
No
Dianne Buckland
Electrical
Hurricane, Utah
Paulene'Walker
91 North 3910 West
CERTIFICATE OF DEATH
State File Number °2010001416
John Palmer Cleaver
Time of Death
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type: I
INFORMANT INFORMATION
Name: Dianne Cleaver Relationship:
Mailing Address: 91 North 3910 West, Hurricane, Utah 84737
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: Metcalf Mortuary, St. George, Utah
Date of Disposition: February 3, 2010
00:46
Washington
August 9, 1927
Male
Married
Electrical Contractor
High School or GED c
Palmer Cleaver
Home
FUNERAL HOME INFORMATION
Funeral Home: Metcalf Mortuary r
Address: 288 West St George Blvd, St George, Utah 84770
Funeral Director: Todd C Bonzo
MEDICAL CERTIFICATION
Medical Professional: 6 Scott Parkinson MD, IHC Health Center, 577 South River Road, St George, Utah 84790
CAUSE OF DEATH
Myocardial Infarction
HTN, Hyperlipidemia, CKD
Tobacco Use: Unknown if User
Medical Examiner C9ntacted: Yes Autopsy Performed: No Manner of Death: Natural.'
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
AA■" "'1.4 11rr document displays the -date, seal and signature of the State Registrar and the County/District Health Officer.
1 Y
N� /ry O y TF {(4r
�15 7.n 1 gy vt
David W. Blodgett
Director/Health Officer
County/District Health Department
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'Barry E. Wangle, State Registrar 0 6 1 7 0 9 1 9 2
Office of Vital Statistics