HomeMy WebLinkAbout954043I, E. Susan Shaw, being of lawful age and duly sworn according to law, upon my
oath, depose and state:
That under the date of November 10, 1995, for valuable consideration, Leisure
Valley, Inc., a Nevada Corporation, by deed of that date, which deed was duly filed of
record in the Office of the Lincoln County Clerk, on November 29, 1995, in Book 376PR,
Page 780, conveyed to Dwight L. Shaw and E. Susan Shaw as joint tenants, the following
described land, in the County of Lincoln, State of Wyoming, to -wit:
Star Valley Ranch RV Park Plat One Lot 96 as platted and recorded in the official records
of Lincoln County, Wyoming
That by reason of said conveyance aforesaid, the said Dwight L. Shaw and E.
Susan Shaw as joint tenants, became owners of said real property, and the title thereto
vested in them continuously from the date of said conveyance, to the date of death of
Dwight L. Shaw on the 4th day of January, 2009. That by reason of and upon the death
of Dwight L. Shaw, title in the above described real property vested in E. Susan Shaw as
the surviving tenant.
Affiant avers and certifies that Dwight L. Shaw, is the identical party named with
E. Susan Shaw in the aforementioned deed, whose death terminated his 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.
Dated this 17th day of June
Affidavit of Survivorship
WITNESS my hand and official seal,,..
My Commission Expires: 3/5/2016
This pact is being recorded by
Rocky Mountain Title Insurance Agency
of Lincoln County as a COURTESY only
2010.
Cathy J Springer Residing in Eagle, ID
CATHY SPRINGER
N OTARY P IBI..IC
STATE O6: :D HO
00
d 601)41/K. t
E. Susan Shaw
Idaho RECEIVED 6/21/2010 at 2:30 PM
State of RECEIVING 954043
Coun of Ada SS. BOOK: 749 PAGE: 334
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Subscribed and sworn to before me, a notary public in and for said County and
State, by E. Susan Shaw, this 17th day of June 2010.
Notary Public
1
CERTIFICATION OF VITAL RECORD
CERTIFICATE OF DEATH
�:.DateFile'Id U A ��NU A I RIY X09 2009 2009-00.026
Slate File No.
MALE
MANNER OF DEATH
NATURAL
„�5!IIIiiIIIP
.J■AMEOF CERTIFIER, TITLE
BANU SYMI'NGTON, M.D. PHYSICIAN/
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
DECEDENT LEGAL NAME
DWIGHT LEROY SHA
BIRTHPLACE
BERGER', IDAHO
y MARITAL STATUS AT MME OrmATH
MAR R�IX�I�D I ,I
FATHER NAMED
THOMAS IRVING SHAW
MOTHER MAIDEN NAME
ALBERTA SCHULER
METHOD OF DISPOSITION
CREMATION
CAUSE OF DEATH (underlying cause last)
a
RESP FAILURE
DUE TO (or as a consequence of)
b MULTIPLE =MYELOMA
DUE TO (or as a consequence of).
�!IllaArE OFINJUF(Y
ll�l li Nil Ili i
LOCATION WHERE I W URY OCCURRED
-DESCRIPTION OF HOW` {WURY OCCURRED'
SOCIAL SECURITY NUMBER.
TIME. OFINJURY
DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
AGE
88 YEARS
FUNERAL SERVICE LICENSEE
KEVIN L ROSENAU
NAME AND ADDRESS .OFFUNERAL FACILITY
WHITE MORTUARY, INC., TWIN FALLS, IDAHO
DATE OF DEATH TIME OF DEATH
JAN. 04, 2009 1:05 A.M.
JANUARY 12, 2009
ti ISSUED:
0 Copy is not valid unless, prepared on engraved border
disOlaying state seal and signature of the Registrar.
n; n, i ii it
DUE� °n l a l t1 11 i cons ance lhfli iallll
dal '11' �V 111
Ili liy t illy. i re,i I
OTHER SIQNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting in the underlying cause given above
NONE STATED
PLACE OF RESIDENCE
TWIN FALLS, IDAHO
NAME OF SURVIVING SPOUSE (If vile maiden name);
E. SUSAN WALLACE
CITY,TOWN OR LOCATION OF DEATH
TWIN FALLS, IDAHO
PLACE OF INJURY
Nu This is a true a reproduction of'the document officially registered and placed
on file with the IDAHO BUREAU OFyITAL RECORDS' AND HEALTH STATISTICS.
DATE OF BIRTH
NOVEMBER 03, 19211
JANE S. SMITH
STATE REGISTRAR
BIRTHPLACE
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
COUNTY OF DEATH
TWIN FALLS
Approximate Interval Between
Onsetand Death
HOURS,
1 1
IOW U1P WJ U RAM iLIMP