HomeMy WebLinkAbout954952Affidavit of Survivorship
I, Dr. Darcy W. Turner, being of lawful age and duly sworn according to law,
upon my oath, depose and state:
That under the date of June 18, 1993, for valuable consideration, Dorothy L.
Liner, by deed of that date, which deed was duly filed of record in the Office of the
Lincoln County Clerk, on June 22, 1993, in Book 331PR, Page 57, conveyed to Dorothy L.
Liner, Nancy L. Leach, Dr. Darcy W. Turner, Craig Turner, John Turner and Charlette L.
Martin, as joint tenants with rights of survivorship, the following described land, in the
County of Lincoln, State of Wyoming, to -wit:
All of Lot Numbered Ten (10) of Block Numbered Forty -Five (45) of the Second Addition
to the Town of Kemmerer, Lincoln County, Wyoming LESS AND EXCEPT THE
FOLLOWING:
Beginning at the northeasterly corner of said Lot 10, and running thence southerly along
the easterly boundary of said lot, a distance of 4 feet, 2 inches; thence westerly, parallel
with the northerly and southerly boundaries of said lot 10, a distance of 125 feet to the
westerly boundary of said lot; thence northerly 4 feet, 2 inches; thence easterly 125 feet
to the northeasterly corner of said lot, the place of beginning
That by reason of said conveyance aforesaid, the said Dorothy L. Liner, Nancy L.
Leach, Dr. Darcy W. Turner, Craig Turner, John Turner and Charlette L. Martin became
the 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 Charlette L. Martin, also known as
Charlette Lynn Martin, on the 21st day of May, 2009, and the date of death of Dorothy L.
Liner, also known as Dorothy Louise Liner, on the 29th day of June, 2010. That by
reason of and upon the deaths of Charlette L. Martin and Dorothy L. Liner, title in the
above described real property vested in Nancy L. Leach, Dr. Darcy W. Turner, Craig
Turner and John Turner, as joint tenants with rights of survivorship.
Affiant avers and certifies that Charlette L. Martin, also known as Charlette Lynn
Martin, and Dorothy L Liner, also known as Dorothy Louise Liner, are the identical
parties named with Nancy L. Leach, Dr. Darcy W. Turner, Craig Turner and John Turner
in the aforementioned deed, whose deaths terminated their interest, title and estate in
said real property; and Affiant attaches hereto and makes a part of this affidavit, copies
of the Official Certificates of Death of said decedents, duly certified by the public
authorities in which said death certificates are a matter of record.
Dated this C day of £UZazzUS1" 2010.
State of uxp -A t 11J6::.
ss.
County of L-11,-)a./c))
Subscribed and sworn to before me, a notary public in and for said County and
State, by Dr. Darcy W. Turner, this day of 4.-UCQLL 2010.
WITNESS my hand and official seal.
Sion Expires: la 2Cz CD
RECEIVED 8/16/2010 at 3:03 PM
RECEIVING 954952
BOOK: 752 PAGE: 100
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
arcy W. Turner
A.
Notary Public
1
TYPE OR
PRINT IN
PERMANENT
BLACK INK
DO NOT USE
FELT TIP PEN
DISPOSITION
PLACE OF
DEATH
DATE OF
DEATH
CAUSE OF
DEATH
ITEMS 32.38
TO BE USED
FOR EXTERNA
CAUSES ONL
(CORONER)
IF DEATH WAS
DUE 10 OTHER
THAN NATURAL
CAUSES,
THE CORONER'.
8(65_T
COMPLETE AND;
SIDI/THE
CERTIFICATE:
C DATE ISSUED LY (J 7( r LJ CJ
41 This copy is not vali 01055 p ayed on engraved border
Vi
displaying state,seal nd signature of the Registrar.
DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
STATE OF IDAHO f
This is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF'•VITAL RECORDS AND HEALTH STATISTICS.
JANE S. SMITH
STATE REGISTRAR
State of Idaho
950 5E
CERTIFICATE OF DEATH
ONLY Of PAS DOCUMENT.OSRT91EDe ME T R E TRAS WIN TIM dE LTN AND WELFARE /O
l USED AS MI. FACIE WOMB OfTNS OWN LINGER Srw2r1147ANO 10. •.10AN0 CODE Local Reg. NO.
1,DECEDEIIrS LEGAL NAME (Include AKA's if any( (First, Midrib, Last, Suffix). 2. SEX 3. SOCIAL SECURITY NUMBER.
DOROTHY LOUISE LINER FEMALE
N 4a, AGE -Last Birthday 4b,UNDER 1 YEAR '4C, UNDER 1 DAY 5, DATE OF BIRTH (Mo /Doy/ 6. BIRTHPLACE (Cly end State, TerNtori or Foreign Country)
17 Months Days Hours Minutes
02/06/1930 SALT LAKE CITY, UTAH
`0 80 (years), i
78. RESIDENCE STATE OR FOREIGN COUNTRY 714, COUNTY 7c. CITY OR TOWN
WYOMING LINCOLN KEMMERER
C 7d: STREET AND NUMBER 7e. APT. NO. 7f, ZIP COOS 7g. LI INSIDE CITY
MITS
1033 BEECH AVENUE 83101 U Yes 0 No
N 8. MARITAL STATUS AT TIME OF DEATH 9. SURVIVING' SPOUSE'S NAME (If wife, give maiden name)
LL
0 Married 0 Married, but 600050700 Widowed 0 Divorced 0 Never married 0 Unknown
z., 10. EVER IN U.S. 110; FATHER'S NAME (First, Middle, Lest, Suffix) 1114. BIRTHPLACE (Slate; Territory, or Foreign Country)
•C ARMED
FORCES? ALBERT FAXTON STRINGFELLOW TEXAS
N
0 Yes. 120, MOTHER'S MAIDEN 0406 (First, Middle, Last, Sumo) 1214, BIRTHPLACE (Stale; Territory, or Foreign Country)
E ®H" ROSE LEONA FOREMAN I UTAH
tJ
O 730, INFORMANT'S NAME (Type oY print) '1314, RELATIO SHIP 70 DECEDENT 130, MAILING ADDRESS (515001 and Number; City, State, Zlp'.Code)
Z JOHN TURNER' SON 588 VICTOR CHUBBUCK, ID 83202
Q 14 METHOD OF DISPOSITION 15, PLACE OF DISPOSS1ON (Name and address of cemetery O
•16. NAME AND COMPLETE ADDRESS F FUNERAL FACILITY
0 Burial Cremauor) crematory; other place)
I" 0 Donation 0Entombment AFTON MEADOWS CREMATORY WICKS FUNERAL HOME
0 Removal from Idaho 211 WEST CHUBBUCK ROAD 211. WEST CHUBBUCK ROAD
0 Other (Specify) CHUBBUCK, IDAHO $3202 CHUBBUCK, IDAHO 83202
•17a. SIGNATURE OF FUNERAL SERVICE UCENSEE ACTING AS SUCH 1714. LICENSE NUMBER (Of lice see) 16. CAUSE CONTACTED
DUE 70 C
DUE TO AUBE OF DEATH?
ELECTRONICALLY FILED: BROCK WICKS' t M1071 D Yes ®No
L PLACE OF DEATH (19.221
190, IF DEATH OCCURRED IN A HOSPITAL 19b. IF DEATH OCCURRED SOMEWHERE OTHER THAN A HOSPITAL;
10 Inpatient 2 OER/OUlpatlenl 3 000A 4 OH08pIde facility 5 Nursing home/Long term 0050Taoilly 60Deoedenl's home' 70 Other (Specify)
20,FACILITY NAME (11831 facility, giveslreet and null a1) 21, CITY, TOWN, OR LOCATION OF DEATH AND ZIP CODE 22. COUNTY OF DEATH
POCATELLO CARE AND REHABILITATION CENTER POCATELLO,ID 83201 I BANNOCK
I
1 I
23. SATE OF DEATH (Mo /DaylYr) (Spell month) 24, TIME OF DEATH 25. DATE PRONOUN6E0 DEAD (MO /Day/Yr) (Spell month) 26, TIMEFRONOUNCED DEAD
(24Fr), (241,1)
June 29,2010` I 15:15 June 29,2010 1 15:15
27, CAUSE OF DEATH
PART 1. Enter me chain of oA4rits diseases, in/ arias, or complications -that directly 600884 the deolh?OO NOT enter terminal events such as cardiac Approximate 10(07101:
erred, respiratory arrest, or ventricular fibrillation without showing 1140 etiology. 00 NOT ABBREVIATE. only one cause on a tide: onset t0 Death
IMMEDIATE CAUSE (Final BILATERAL PULMONARY EMBOLISMS 8 DAYS
disease or condition a
resulting In 00011,) DUE TO (or as a consequence off.
,t., Sequentially 1,81 conditions, y UNKNOWN
p if any, leading to the ceuee DUE TO (or as a consequence o0•
listed online a, Enter the I
UNDERLYING CAUSE 0;
0 LAST (disease or injury DUE TO (or as 0 consequence o0:
g that initiated the events
p res{lltlog in death) d
l P80711, Enter olh8,oionificant oongitlo(78 tribubn3 to death but not resulting In the underlying 00080 9)800 in Pan I 260. WAS AN AUTOPSY 286. WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE TO COMPLETE
NONE r THE CAUSE OF DEATH?
29. DID TOBACCO USE 30, IF FEMALE (Aped 10.54): O Yes 0 N 0 Yes 0 N0
m CONTRIBUTE TO 084714? 0 Not pregnant Wllhln 7857 year 0 601 pregnant but pregnant 43 days 31, MANNER OF DEATH
701 year before death
n 0 Yes 0 Probably 0 Pregnant al time ordeeth 0 Natural 0 Homicide
o 0 No 0 Unknown 0 7001 pregnant, but pregnant 0 Unknown if pregnant Within me pest 0 Accident 0 Pending Investigation
U within 42 0070 of death year 0 Suicide 0 Could 001 be determined
32, DATE OF INJURY (MO/Day/Yr) 33, TIME OF INJURY 34. PLACE OF INJURY (Decedent's hpme /arm 011801, consiruclion site, 35. INJURY AT WORK?
W (57911 month) (2405) nursing home reslauram,;forest, etc.)
O Yes 0 No
W 36, LOCATION OF INJURY:
Slate City/ Town or County Zip Coda
W Street and Number or Location Apartment Number
V 37. DESCRIBE HOW INJURY OCCURRE TRANSPORTATION INJURY, STATE THE TYPES(S) OF VEHICLE(S) INVOLVED (Automobile, pickup, motorcycle, AT/, bicycle, 878.)
SPECIFY WHICH VEHICLE DECEDENT OCCUPIED, If applicable
TRANSPORTATION 38 W DEDE?ENT: 0 Driver/Operator 0 Passenger 3814, WHAT SAFETY DEVICES(S) DID DECEDENT USE/EMPLOY'?
INJURY ONLY 0 Pedeo11an; 0 Olher 0 Seal bell 0 Child safety seat 0 Helmet 0 4), bag 0 None 0 Unknown
39a. CERTIFIER' Check only one, based on official capacity for this certificate) 35b, LICENSE NUMBER
0 PHYSICIAN 0 PHYSICIAN ASSISTANT 0 ADVANCED PRACTICE PROFESSIONAL NURSE NP -0698
.10 the best of my knowledge; death Occurred at the time, elate. and place, and due to the 89/78(0/ cause(s)/manner stated.
OCORONER t 38c. DATE SIGNED
On the basis of examination and/or investigation. In my opinion, death occurred at Inc tlme dale and place and 480 (0 the 00808)8)
and manner stated. 7 1 2010
5)310105. end Title of 60,011105 ELECTRONICALLY SIGNED: DIANA KRAWTZ, N.P. MM DD YYYY
390. NAME, ADDRESS, AND ZIP CODE OF CERTIFIER (Type or Print)
DIANA KRAWTZ, 465 MEMORIAL DRIVE POCATELLO, ID 83201
I 400. REGISTRAR'S SIGNATURE 40b, OATS SIGNED
�r��- t.:a7�� l l 2010
MM DD YYYY
,il
wei IN to l•■■ Ni MI Era 1st ■Nimpys. Agi
CERTIFICATION OF VITAL RECORD
CER9' FICATE N1041ER.'20 9- 005V54
COUN OF DEATH "SPOKANE
DATE 0F.;1))ATH MAY 21,2009'<
„HOUR, Of OWN. 1.0:05 A.M%
;SEC: FEMALE
SAE 61 :YEARS
SG.CIAL SECURITY NUMBER „5.20 56 2635-
I11SP)kNIC ORIGIN NO.,. NO HISPANIC,
RAc WH1TE'..
ISIS P Y 0'F T FhE R E 0h�D 0 N!F L E C'I<IFT MSC EN TAE RAF °R�H;E�A.L +T HT�AT +I S T I:C S C EaRFT IF,I E D C 0 P I:E..S M (.1'S T,'H`A'J'E T HtE O F F4I!C IAA L S E,A L'
AcER�TIFI,�o co�� 1,a.� ti.
DATE 0'F INJURY;
HOUR OF INJURY:
INJURY'AT "WORK?
PLACE OF" INJURV
L'l1CA:TION OF INJURY:;;
CITY
COUNTY"
DESCRIBE (jAIU'ItNJURY'",06CURRED:
STATUS OF VECEDENT,?,IF k•T.RANSPORTATn0N UJURYc
;APPLICABLE
TEN(S) AMENDEV NONE
NU BER(SI?, NONE
;DATE (S)
O F LN T zN
E PzA•R�T M'EvN T O'F`i A LT H
MANLIER OF NATURAL
AUTOPSY NO
AVAILABLE TO COMPLETE THE CAUSE VEATH ?-NOD APPLICABLE
DID‘TOBACCO USE CONTRIBUTE TO*VEATH YES
PREGNANCY STATUS, IF FEMALE: NOT APPLICABLE;
CERTIFIER NAME: BRUCE,A CUTTER MD
'1 -'PHYSICIAN
CERTIFIER':
ADDRESS:, 601 S, SHEJtMAN ,ST
CITY STATE,ZTP: SPOKANE 99202
E STGMED: MAY 21;,2004;
CASE R> FERRED''O ME /"COROtffl4 YES
PILE NUMB> ?lz (JOf APPLICABLE
ATTENDING PHYSIC43W
■,OT.APPLICABLE
1,0CAC•,1 EfUTV.REGISTRAR
PEGGY J W1;T,,MORE
DATE RECE"IyE:v: MAY 26,2D09
VATS I $UEV: 0& /02'J20ad
FEE %NUMBER 000M0106;1'.
3.3 O1.O03(5/99)
aV
�Ir
81RTHDATE':; OCTOBER `20,144,b°
BITITHPI ACE •BURLEY, IPAHO
MARITAL STATUS •DIVORCtD
SPOUSE
OCCUPATION PAINtER
INVUSTRV, ART"
EDUCATIOM -12TE1 GRADE, NO'VIPLOMA
IJS -ARMED. FORCES:? NO
/,INFORMANT: kAL:Alq MARTIN
RELATIONSHIP: SON
6,121 bTH AVE .K11`9,;SPOKANE VALLEY,
'•CAU'SE °OP- DEATH':
METASTATIC NON- .SMAL•L,CELL• LUNG'CANCER
INTERVAL 3 MONTHS,
INTERVAL`:
'INTERVAL:
INTERVAL
OTHER:CO.NDITIO CONTRIBUTIOG TO.DEATH:
PLACE OF 'DEATH: %HOSPICE FACILITY
FACILITY OR ADDRESS :HOSPI :HOUSE OE .„SPOKANE
CITY, STATE, •ZIP.:SPOKANE, WASHINGTON 5920,2
'RESIDENCE STREET: 6121 E. 6TH AVE°El K119,
CITY,: STATE, ,ZIP:: SPOKANE VALLEY.;' WASHINGTON 9921
1NS'IDE•'CITY LIMITS? VES..
C OUNTV:.SPOkAN£
TRI$AL''RESERV ATION: NOT APPLICABL
LENGTH: OF TIME AT ,RESIDENCE:; 2 MONT)IS
FATHER WILL"IA1IMAXEY
MOTHERS DOROTHY STRINGFELLOW
METHOD, OF DISPOSITION; CREMATION
PLACE OF DISPOSITION: FOOTHILLS 'CREMATORY
CITY, °STATE: SPOKANE; WA
'OISPOSITI.ON VATS: 'MAy 2.0Q9
'FUNERAt FACICITY SPOKANE CREMATION;& BURIAL'
ADDRESS -2832 N RUBY
CITY, STATE, ZIP SPOKANE. 'WA 99261'
FUNERAL DIRECTOR WILLIAM V ROSSEY
WASHINGTON, 99212
ci