HomeMy WebLinkAbout953942STATE OF UTAH
COUNTY OF
I, David W. Despain, being of lawful age and duly sworn according to the law,
upon oath depose and say:
1. That Bessie A. Despain was my spouse. She passed away on February
19, 2010, more than 30 days ago. A certified copy of the Death Certificate is attached
and made a part hereof as Exhibit "A
2. That by certain Lincoln County, Wyoming, Certificate of Title No 19- 78215,
Bessie and I were owners of a 1962 Ford Falcon, VIN 2K12U124155. Copy of said
title is attached and made a part hereof as Exhibit "B I am requesting a new title be
issued for this vehicle in the name of David W. Despain and David J. Despain, both of
2518 West Brucemont Drive, in Taylorsville, UT 84118, and Alice Ann Shaffer, of 760
North Catherine Street, Salt Lake City, UT 84116;
3. That there is no probate in effect for the Estate of Bessie Despain and that
I, David W. Despain, was her spouse and the automobile title should now be in my
name and our children's names only. David J. Despain and Alice Ann Shaffer are our
only children;
4. The value of this vehicle is far less than $150,000; and
5. Affiant sayeth not further.
DATED this day of
*Vcr-y...4ise
DAVID W. DESPAIN DAVID J. D SPAIN
LICE ANN SHAFFER
AFFIDAVIT
)ss.
2010.
o& 884
RECEIVED 6/14/2010 at 12:40 PM
RECEIVING 953942
BOOK: 748 PAGE: 884
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT
Despain/Despain /Shaffer
Page 1 of 2
SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State
and County above mentioned by David W. Despain on this 1 51- day of J
2010.
WITNESS my hand and official seal.
N ATHAN laghlio I
Commission #574990 I
My Commission Expires
July 1, 2012 I
State of Utah
SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State
and County above mentioned by David J,. Despain on this 2 day of )1A f
2010.
WITNESS my hand and official seal.
IW.... SIP IMO Cast 111
Notary Public
ALISON PALMER I
Commission #574931 f
My Commission Expires
July 30.2012 I
State of Utah
SUBSCRIBED AND SWORN to before me, a Notary P blic in and for the State
and County above mentioned by Alice Ann Shaffer on this Z P day of
2010.
WITNESS my hand and official seal.
NOTARY PUBLIC
LA TINA f;DELAW 2700 IDE 11OTULELEI
10
take ClW Utah &411
My Commissi E ire$
October 4, 20 71
STATE OF UTAH
674
NOTARY PUBLIC
My Commission Expires: 1/ I /TO
NOTARY PUBLIC
My Commission Expires: 1 SO) 12
AFFIDAVIT
Despain/Despain/Shaffer
Page 2 of 2
448721
This is a true certification of the document on file in the office of Vital
0 Records Services, Cheyenne, Wyoming,
DATE ISSUED: Thursday, February 25, 2010
This op is not valid unless prepared on paper vvith an engraved border.
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Deat
Date of Death:
City of Death:
Location:
Additional Decedent Information:
Place of Birth: Evanston, Wyoming
Residence: Afton, Wyoming
Marital Status: Married David DaviWayne Despain
Armed Forces: No
Name of Father: James C Turner
Name of Mother: Bessie Maud Danks
Alice Ann Shaffer Relationship: Daughter
Disposition
p M i e a t c h e od ot o i D ap i s o i t E B v u a ri: I too
s Cemetery, Evanston, Wyoming
Funeral Home or Facility: Schwab mortuary,
Afton, Wyoming
Cause of Death:
The immediate cause th e followed by any underlying causes.
is
(a) colon cancer listed on
Other Significant
Conditions:
Manner of Death:
Certifier
Type:
Name:
Address:
Date Filed:
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State.File.NOrnbet:
Bessie A. Despain
Female
October 16, 1929
February 19, 2010 C ounty of Death
Aftrsn
d Center'
Hospital Lane
Star Valley me Ica en
\Social Security Number:
Age at the
physician
Allen D. Carter, M.D.
110 Hospital Lane, PO Box 579, Afton, Wyoming, 63110
Time of Death:
•-v
Gladys K. Breeden 0
Deputy State Registrar
'ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE
EXHIBIT "A"
19- 78215
STATE OF WYOMING
OFFICE OF COUNTY CLERK
UINTA COUNTY
EVANSTON. WYOMING
aertificate of `teak for Altar
DESCRIPTION OF VEHICLE
Make___ '.urd Year__1362 V. L N. 2K1211_124J.55
Body Vehicle
Type F} Type __12a as Model Falcon for Used
Previous Title No191-50$38 state W.yo
Factory
Cost 1923.
Name of Owner__ De p.a?_n ._mss lST1�_�^l.__aA
(Signature of Owner)
Address___P_O_}3DX CS23 City Afton st WyO
Date Purchased __1Q47./_77 Purchased From Beaa1e_ and__Ray J Turner
Address City_ SIEVafl t_on State WyO
VEHICLE SUBJECT TO THE FOLLOWING LIENS AND NO OTHERS
SPACES BELOW FOR COUNTY CLERK USE ONLY
No.19 78215
Date
Issued
EXHIBIT `B"
$2.00
10/7177
FIRST LIEN
Nature of Lien Amount Date of Filing
Lien Holder Address
Clerk's Signature By Deputy
Above lien discharged from County Clerk's Records. Date of Discharge
Clerk's Signature By D epu t y
SECOND LIEN
Nature of Lien Amount Date of Filing
Lien Holder Address
Clerk's Signature By Deputy
Above lien discharged from County Clerk's Records. Date of Discharge
Clerk's Signature By Deputy
THIRD LIEN
Nature of Lien Amount Date of Filing
Lien Holder Address
Clerk's Signature By Deputy
Above lien discharged from County Clerk's Records. Date of Discharge
Clerk's Signature By Deputy
CERTIFICATE
1, KATHLEEN R. LANE County Clerk UINTA County,
Wyoming, do certify that the above applicant has stated under oath that _he is the owner of the above
described motor vehicle and that such motor vehicle is subject to the liens listed above and no others.
I hereby certify that reasonable diligence has been exercised in ascertaining that the facts stated in
the application for a Certificate of Title are true, and that this instrument was filed for record on the
7 day of OctS2li r. 19 77 at 2_;_30 o'clock P M., and duly
recorded in Book 17 Page of the records of this office.
IN WITNESS WHEREOF, I have hereunto caused this Certificate to be signed and the official seal
of this office to be placed thereon.
(SEAL)
By 1 -r -Kati l.-eSE1 e
Deputy County Clerk
(Do not alter or lose this Certificate as it must be presented at the County Treasurer's office when procuring motor vehicle licenses
and must be used in making a sale or transfer. When title Is transferred, application for new certificates must be made to a County Clerk
within ten days after the assignment on the reverse side hereof is executed.
IMO THE Mille OOMPARY, SHERIDAN 146729