HomeMy WebLinkAbout954955I, Shirley J. Eatough, being of lawful age and duly sworn according to law, upon
my oath, depose and state:
That under the date of July 23, 1982, for valuable consideration, Michael A.
Jetkoski, an individual, and for Tammy L. Jetkoski and Heidi J. Jetkoski, by deed of that
date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on
July 23, 1982, in Book 189PR, Page 573, conveyed to Floyd C. Eatough and Shirley J.
Eatough, husband and wife, as tenants by the entireties, the following described land, in
the County of Lincoln, State of Wyoming, to -wit:
The Lot No. Two (2) of the Block No. Ten (1o) of the Amended Plat of the Town of Opal,
County of Lincoln, State of Wyoming
That by reason of said conveyance aforesaid, the said Floyd C. Eatough and
Shirley J. Eatough 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 Floyd C.
Eatough, also known as Floyd Carl Eatough, on the 5th day of July, 2010. That by reason
of and upon the death of Floyd C. Eatough, also known as Floyd Carl Eatough, title in
the above described real property vested in Shirley J. Eatough.
Affiant avers and certifies that Floyd C. Eatough, also known as Floyd Carl
Eatough, is the identical party named with Shirley J. Eatough 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.
State of tA=1-4 t 1JCa
County of L..1 IIaCc�1
WITNESS my hand and official seal.
Affidavit of Survivorship
Dated this i Iv" day of 2010.
ss.
n Expires: 19 2it110
Shirl J. Eatough
Subscribed and sworn to before me, a notary public in and for said County and
State, by Shirley J. Eatough, this 10 day of 41-1.LCQ.U_576 2010.
Notary Public
RECEIVED 8/16/2010 at 3:13 PM
RECEIVING 954955
BOOK: 752 PAGE: 121
JEANNE WAGNER
121
vrnnn nrrnrrl inns
Tik
Date and Place of Death.: 2
Date of Death' July 05; 2010 County of Death:
City of Death: Kemmerer
Location: South Lincoln 'Medical Center PO Box 390
Additional Decedent Information:
Place of Birth: Charleston, Utah
Residence: Opal, Wyoming
Marital Status: Married Shirley Jolean Long
Armed Forces: Yes
Name of Father Melvin Etough
Name of Mother Ellen Simmons
Informant: Shirley Jolean Etough Relationship:
Disposition:
Method of Disposition: Removal from State
P of Disposition: UFD Cremation Center, South Jordan, UT.
Funeral Home or Facility:
Facility: Ball Family Chapel; Evanston, Wyoming
Cause of Death:
The immediate cause 1s listed on the first line followed by any underlying; causes.
(a) Cardiopulmonary Failure
(b) End Stage COPD
Decedent:
Name:
Gender:
Date of Birth:
Floyd Carl Etough
Male
November 03, 1926
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
CERTIFICATI
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State Pile Number:
Physician
Vincent Hinshaw, DO
PO Box 390, Kemmerer, .Wyoming, 83101,
July 23 2010
Age at the Time of Death:
Time of Death:
2010- 002200
83 years
fa
sv'
475565
This is a true certification of the document on file in the office of Vital
Statistics Se vices, Cheyenne, Wyoming,
BATE ISSUED: Monday, July 26 2010
VITAL RECORD
P�r
I[�
Oladys K. Breeden
copy is not valid unless prepared on paper with rip engreyed. border