HomeMy WebLinkAbout955382State of WY
ss.
County of Lincoln
75.
Witness my hand and official seal.
Affidavit of Survivorship
Delbert D. Rentfro and Bette J. Rentfro Revocable Trust Dated January 3, 2008,
being first duly sworn upon His /Her oath, deposes and states as follows:
Not ry Public
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000361
1.On the 7. 206a; my husband /wife, Delbert D. Rentfo 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 wife /husband jointly owned certain real property with
me, said real property being located in the County of Lincoln, State of Wyoming, and
more particularly described as follows:
The South half (30) feet of the Lot Numbered Three (3) and all of the Lot Numbered Four
(4) (60 feet) of the Block Numbered Sixteen (16) of the Original Town of Cokeville,
County of Lincoln, State of Wyoming
3. Said real property was originally conveyed to Delbert D. Rentfro and Bette J.
Rentfro, or their Successors, as Trustees of the Delbert D. Rentfro and Bette J.
Rentfro Revocable Trust Dated January 3, 2008, by Delbert Dwayne Rentfro and
Bette J. Rentfro, dated January 3, 2008, and recorded in the office of the Lincoln
County Clerk and Ex- Officio Register of Deeds January 16, 2008, in Book 684 at Page
4. By reason of Delbert D. Rentfo death, I am entitled to sole ownership of the
above mentioned real property.
Dated this 9-~ ,2010.
Subscribed and Sworn to and acknowledged before me this g 3 ,2010
by Bette J. Rentfro.
RECEIVED 9/9/2010 at 10:34 AM
RECEIVING 955382
BOOK: 753 PAGE: 361
JEANNE WAGNER
1 INr r1I nl r`rli INTY ri FRK KFMMFRFR WY
CERTIFICATIO
ITAL RECORD
City of Death:
Age:
Place of Birth:
Armed Services
Spouse's Name
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
Method of Disposition:
FUNERAL HOMEINF
MEDICAL CERTIFICA
CAUSE OF DEATH
Natural Cause
Tobacco Use: Unknow
Medical Examiner Co
DECEDENT INFORMATION
Date of Death: `'November 27, 2008
Logan
79
Maple Hill`s, Kansas
No:
"Bette Jane "Robison
Phosphate Mining
Cokeville, Wyoming
Eva Pearl Nauman
Logan Regional Hospital
INFORMANT INFORMATION
Name:. Bette Jane Rentfro Relationship
Mailing Address:. 115 Pearl Street, Box333, Cokeville, Wyoming "8311
DISPOSITION INFORM
ATION
Burial'
Place of bisposton:
Cok'evilleCemetery, Cokeville, Wyoming
Date of Disposition:
Decem. ber 1
OR
Funeral Home: ION
llalthews',Morluary
Address:
7b2�ryClay,Stree�t Montpelier, Idaho 832
Funeral Director: 54
Leonard', Matthews
�TIO
Medical Professional f
,William B Evans MD, 590Y`East 1400North, ,Lo'gah UtaFt X4314
n ;if User
ntacted No `Autopsy Pe
Date Issued: Septem
ber
STAT UTAH
CERTIFICATE OF DEATH
State File Number: 2008013351
Delbert DeWayne Rentfro
This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Bolder, 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 of Vital Statistics.
I,I III I 1 1I UTAH DEPARTMENT OF HEALTH
0 6 2 6 5 0 4 4"9 Office of Vital Records Statistics
Salt Lake City, Utah
Time of Death:, 00:54
County of Death: Cache
Date of Birth: November 29, 1928
Male
Marital Status: Married
Usual Occupation: Supervisor
Education: High School! or GED
Father's Name: George LeRoy Rentfro
Facility Type: Hospital ER
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Barry E. Nangle
tate Registrar
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