HomeMy WebLinkAbout954689Affidavit of Survivorship
549
I, Thomas G. Baker, being of lawful ate and duly sworn according to law, upon
my oath, depose and state:
That under the date of September 11, 2006, for valuable consideration, Andersen
Living Trust dated 8- 20 -96, Janett B. Andersen, Surviving Trustee, by deed of that date,
which deed was duly filed of record in the Office of the Lincoln County Clerk, on
September 18, 2006, in Book 634, Page 42, conveyed to Thomas G. Baker and Judith A.
Baker, husband and wife, the following described land, in the County of Lincoln, State of
Wyoming, to -wit:
Lot 179 in Star Valley Ranch RV Park Plat 1, Lincoln County, Wyoming as described on
the official plat thereof
That by reason of said conveyance aforesaid, the said Thomas G. Baker and
Judith A. Baker, husband and wife, 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 Judith A. Baker, also known as Judith Ann Baker, on the 20th day of December,
2008. That by reason of and upon the death of Judith A. Baker, title in the above
described real property vested in Thomas G. Baker, the surviving spouse.
Affiant avers and certifies that Judith A. Baker, also known as Judith Ann Baker,
is the identical party named with Thomas G. Baker 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.
Dated this 2 day of A-C1.0'IA -S+" 2010.
State of Wt. om
County of L-/NCO Lr\I
ss.
RECEIVED 8/4/2010 at 1:49 PM
RECEIVING 954689
BOOK: 751 PAGE: 549
JEANNE WAGNER
I INCOI N COUNTY CI FRK KFMMFRFR WY
Thomas G. Ba
Subscribed and sworn to before me, a notary public in and for said County and
State, by Thomas G. Baker, this ,i� day of 1 4-u gris 2010.
WITNESS my" and o seal.
SHERYL MANNING NOTARY PUBLIC
County of a State of
Lincoln '+1 <i' Wyoming
My commission Expires
av 1 Notary Notary P
My Commission Expires: NO V 7 /2
1
DECEDENT INFORMATION
Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:\
Residence:
Mother's Nara..:
Facility or Address:
December 20, 2008
Hurricane
61
/Salt Lake City, Utah
No
Thomas Gordon Baker
Transportation
Hurricane, Utah
Margorie Gafane
122 Overlook Lane
CERTIFICATIO ITAL RECORD
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: Hites Crematory, Henderson, Nevada
STATE
CERTIFICATE OF DEATH
State File Number: 2008014251
Judith Ann Baker
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
INFORMANT INFORMATION
Name: Thomas Gordon(Baker Relationship:
Mailing Address: 122 Overlook Lane, Hurricane, Utah 84737
FUNERAL HOME INFORMATION
Funeral Home: McMillan Mortuary
Address: 265 West Tabernacle Street, St George, Utah 84770
Funeral Director: Robert K McMillan
MEDICAL CERTIFICATION
Certifying Physician: G Gregory Last MD, Intermoutain Health Center Hurricane, 90 South 700 West, Hurricane, Utah 84737
CAUSE OF DEATH
Pulmonary Hypertension
Liver Failure
Tobacco Use: Probably. Contributed
Medical Examiner Contacted: No Autopsy Performed: No Manner of Death: Natural
December 22, 2008
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 the State. Registrar and the County /District Health Officer.
11
11
11
11
Husband
Date of Disposition: Decembef 23, 2008
05:00
Washington
November 2, 1947
Female
Married
Truck Driver
Some College but No Degree
Vemon Birningham
Home
David W. Blodgett
Director /Health Officer
County /District Health Department
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