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Home My WebLink About955171State of WY) ss. County of Lincoln) Affidavit of Survivorship Jeanne Suter, being first duly sworn upon Her oath, deposes and states as follows: 1.On the (3 3 my husband, Derrell Suter passed away, as is evidenced by the official certificate of death attached hereto and incorporated herein by this reference. 2. At the time of death my husband and I were joint MORTGAGEES on real property, said real property being located in the County of Lincoln, State of Wyoming, and more particularly described as follows: SEE ATTACHED EXHIBIT A 3. By reason of Derrell Suter's death, I am the sole MORTGAGEE on the Mortgage recorded on June 3, 2005 as Document No. 908944 in Book 587 at Page 502. Dated this Witness my hand and official seal. 000686 Subscribed and Sworn to and acknowledged before me this U 0 1 0 by Jeanne Suter. Dyanna Parker Notary Public County of State of Uncoln Wyoming My Commission Expires June 29, 2011 RECEIVED 8/27/2010 at 11:21 AM RECEIVING 955171 BOOK: 752 PAGE: 686 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY EXHIBIT A S' NE' /a, NE' SE' /a, Lots 1 and 2 of Section 3, T33N R118W of the 6th P.M., Lincoln County, Wyoming. LESS AND EXCEPT any land contained in Quit Claim Deed recorded November 13, 1985 in Book 233PR on page 105 of the records of the Lincoln County Clerk. LESS AND EXCEPT the following described land: A portion of the Suter property, as referred to in the Deed recorded in Book 186PR on Page 430, with the Office of the Clerk of Lincoln County, Wyoming, within the SW'/a NE'/a of Section 3, T33N R118W of the 6th P.M., Lincoln County, Wyoming, the metes and bounds being more particularly described as follows: BEGINNING at the Northwest corner of the Jerry Suter property, as referred to in the Deed recorded in Book 146PR on Page 670, with said Office,said Point of Beginning being 327.50 feet N 0 °18'40" E, along the East line of the NW' /a of said Section 3, from the Marlowe A Scherbel PLS 5368, 1999 location for the Southeast Corner of said NW thence N 0 °18'40" E, continuing along said East line, 300.83 feet; thence S 89 °28'43" E, parallel with the South line of said SW'/4NE' /a, 446.06 feet; thence S 0 °18'40" W, parallel with said East line, 568.33 feet; thence N 89 °28'43" W, parallel with said South line, 313.06 feet to Point in the East line of said Jerry Suter property; thence N 0 °18'40" E, along said East line, parallel with said East line of said NW' /a, 267.50 feet to the Northeast corner thereof; thence N 89 °28'43" W, along the North line of said Jerry Suter property parallel with said South line, 133.00 feet, to the POINT OF BEGINNING. LESS AND EXCEPT the following described land: A portion of the Suter property, as referred to in the Deed recorded in Book 186PR on Page 430, with the Office of the Clerk of Lincoln County, Wyoming, within the NE' of Section 3, T33N R118W of the 6th P.M., Lincoln County, Wyoming, the metes and bounds being more particularly described as follows: BEGINNING at the U.S. General Land Office 1908, location for the Southwest Corner of the SE% of Section 34, T34N R118W; thence S 89 °36'36" E, along the South line of said SE 2660.61 feet to the U.S. General Land Office 1923, location for the Northwest Corner of the NW' /a of Section 2 of said T33N R118W; thence S 0 °20'05" W, along the West line of said NW' /4, 818.75 feet; thence N 89 °36'36" W, parallel with said South line, 2660.28 feet to a Point in the East line of the NW'/a of said Section 3; thence N 0 °18'40" E, along said East line, 818.75 feet, to the POINT OF BEGINNING. TOGETHER with a 60 feet wide Right -of -Way Easement to Heiner Suter County Road No. 12- 127, the center line being more particularly described as follows: BEGINNING at a Point in the East line of the Jerry Sutter property, as referred to in the Deed recorded in Book 146PR, on Page 670, with said Office lying within the bounds of the Right of Way for said County Road recorded in Book 181PR on Page 407, with said Office; said POINT OF BEGINNING being 133.00 feet S 89 °28'43" E, along the North line of the SE' /a of said Section 3, from the Marlowe A. Scherbel PLS 5368, 1999 location for the Northwest Corner of said SE' /a to the Southeast corner of said Jerry Suter property and 30.00 feet N 0 °18'40" E, along said East line to the POINT OF BEGINNING; thence S 89 °28'43" E, parallel with said North line, 343.06 feet; thence N 0 °18'40" E, parallel with said East line, 628.33 feet; thence N 89 °28'43" W, parallel with said North line, 446.06 feet; thence N 0 °18'40" E, parallel with said East line, 1263.48 feet to a Point in the South line of the above described property. 68 DECEDENT DISPOSITION CERTIFIER CAUSE OF DEATH PARENTS STATE OF COLORADO, COLORADO DEPARTMENT OF PUBLIC :HEALTH; AND: ENVIRONMENT HOLD: TO. ;LIGHT TO: WATERWMARK ITAL RECORD; gthv CERTIFICATIO 1 DECEDENT'S NAME (First, Middle, Last) Derrell SUTER 4. SOCIAL SECURITY 60. AGE Last 6b. UNDER. 1 YEAR NUMBER Birthday(Year.) 75 STATE OF COLORADO CERTIFICATE OF DEATH Days 6c. UNDER 1 DAY S. WAS DECEDENT EVER IN U.S. ARMED FORCES? XI Yes D No 98. PLACE OF DEATH' only one) HOSPITAL: 0 Inpatient gER /Outpatient 0 DOA 9b.: FACILITY. NAME (!l not institution, give street and Ste Regional: Medcentcr''.:' 10a. DECEDENTS USUAL OCCUPATION 10b OF`SUSINESS /INDUSTRY (Glvindof work done during most of working life. DDo not useretlred.) 134 :,RES!DENOE -STATE 13b. COUNTY.. Colorado Logan INSIDE LIMITS? 7t] Yes 17, FATHER -NAME (First, Middle, Leaf) Samual Suter.: 208. METHOD OF DISPOSITION Burial 0 Cremation D Removal from State 0 Donation 0 Other (Specify) Oil Field 13p: CITY, TOWN, OR LOCATION Sterl 14. WAS DECEDENT OF HISPANIC ORIGIN? (Specify No or Yes Jr ,es, specify Cuban Mexican,-Puerto Rican,. etc); IXNo El Yes Specty. 21 E SIGNATURE OF FUNERAL DSCTOR OR PERSON ACTING AS 330 S', 2nd St,Box ;1547, Sterling ,COziP:'80751 22a. R STRAR S S1dNATUR 22b. DATE FILED (Mont Day, Year) Deputy Registrar -n e, o It ;,,o/c) 23. IM •F ed H M 24. 0 F DE E AD 25,. WAS CORON NO NOTIFIED? Mont Day year Hour (Yes or No) 11 :53 A March 13 201 11 :53.,AM Yes TO 88 COMPLETED ONLY BY CERTIFYING PHYSICIAN 18. MOTHER-NAME (First; Middle; Last (Maiden Name)) Delores. Rickenbach 20b' PLACE OF DISPOSITION (Name of cemetery, prematpry, or i .otherplaca) 26. To the best. 91 my knpW1a dge dee occurred at the time date an lace and due :to the causes( :end 6� stat d. Signature a I ✓C V F 7. y 28. DATE SIGNED (Month Day, Year) '2-0/o 30, NAME, TITLE AND MAILING ADDRESS OF CERTIFIER /CORONER (Type /Print) Richard C. Lamb, M.D. 620 Iris Drive Sterlin. CO .31. NAME OF ATTENDING PHYSICIAN IF OTHER THAN CERTIFIER (type/print) 32. MANNER OF DEATH Natural 0 Pending Investigation .DAccldent 3: :DSulcide DUndeleriitined Manner Homicide 33a. DATE OF INJURY (Month, Day, Year) 33e. PLACE PI INJURY-A home, farms street, factory office 34. IMMEDIATE CAUSE [ENTER ONLYY,pNE CAUSE PER LINE FF4044 (ay ayy (p) (c(c),) Donoo mode of d ying (e.g. Cardiac? or Respiratory Arreet)aigne. PA (a1.G ,,41,421,,C_ Y..{(i v-'r on�Y CONDITIONS DUE TO RASACONSEQU EOF IF ANY WHICH a GAVE RISE TO (b) 1 i) L STATIN G THE ATECAUSE DUE TO OR AS A CONSEQUENCE OF STATING UNDERLYING CAUSE LAST c) (o) PART OTHER SIGNIFICANTCONDITIONS Conditions contributing to death but not related to cause in II PART I (e.g. n alcohol abuse obes(ty, smoker) 4. ��De� DATE ISSUED MAR 2 3 THIS IS A TRUE CERTIFICATION OF NAME AND FACTS AS RECORDED IN THIS OFFICE. Do not accept unless prepared on ",,tp security paper with engraved bokder displaying.the Colorado state seal.. and signature of the Registrar. PENALTY BY LAW Section 25-Z:118, Colorado Revised .Statutes, 1982, If a person alters, uses, attempts to use or furnishes to another for deceptive use any vital statistics record. NOT VALID IEPHOTOCOP_IED 6. DATE OF BIRTH (Month, Day Year) Aril 19' 1934 ;15. RACE. American Indian, Black White etc, (Specify) STATE FILE NUMBER 1 OTHER 0 Nur Mg Home 0 Residence 0 Other (Specify) 9c.,.CLTY, TOWN, 0,R LOCATION OFDEATH Sterling 11. MARITA STATUS• Married, Never Married, Widowed, Divorced (Specify) Married 13d STREET AND NUMBER 12845 Tumbleweed Drive 3. UATEOF DEATH (Month, •Day, Year) 7. BIRTHPLACE (City and State or Foreign Country) Afton ..W'omin_ 16. DECEDENT'S EDUCATION (Specify only highest (0 through 12) e (13 throu secondary r 1+) 12 19. (NFORMANT•NAME and relationship to deceased. B l e Jeanne uteri if 20c,: LOCATION City or Town, State 9d. COUNTY OF DEATH Logan 12. SPOUSE ((ladle, give maiden name) Mueller Billie Jeanne Sterling, Colorado 21b. NAME AND ADDRESS OF,FACIL TY:,J Tennant Funeral Home Crematory ..:.:TO BECOMPLETED. BY.CORONER, 27. On thebaslsblexamination and /ortnvestigation'in my opiniortdeath occurred atthe Lime date and place, and'due to the causes) and as stated. Signature 29. DATESIGNED(Month, Day, Year). 33d. DESCRIBE HOW INJURY OCCURRED RONALD: S. HYMAN STATE REGISTRAR 060688 zip: 80751 331. LOCATION (Street and Numb6PorNura('Route Number, Clty State) :;Interval between onset and:death 35. AUTOPSY 36. IF YES were findings considered (Yes or No) In determining cause of death? ;No�`