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STATE OF WYOMING
COUNTY OF LINCOLN
Dated
9 -J D
State of Wyoming
County of Lincoln
My Commission Expires:
)ss.
SS.
AFFIDAVIT TERMINATING ESTATE
I, Jerry Arthur Layton, Trustee being of lawful age and first duly sworn according
to law, upon my oath, depose and state:
1. That I am of adult age, a resident of Lincoln County, Wyoming, and the
Affiant herein.
2. That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 445 PR on page 533 is recorded a Warranty
Deed. The Warranty Deed, dated the 10 day of
Ap 1 1 2000 conveys unto Jerry Arthur Layton and
Lena Mae Layton, Trustees of the Jerry Arthur and Lena Mae Layton
Living Trust, dated February 2, 1996, the following described property,
to -wit:
Lot 61 of Star Valley Ranch Plat 12, Lincoln County, Wyoming as
described on the official plat filed on August 10, 1977 as instrument No.
496703 of the records of the Lincoln County Clerk..
3. That said Lena Mae Layton, Trustee on the 7th day of October, 2009,
died and a copy of the original certificate of death, certified to as true an
correct by public authority in which the original of said certificate is a
matter of record, is attached hereto as Exhibit "B
4. That by reason of death of said Lena Mae Layton, Trustee by reason of
2 -9402 W.S. (1980), the decedents interest and title in said conveyance
has terminated and title to the real property conveyed thereby has vested
absolutely in Jerry Arthur Layton, as sole Trustee, continuously since
the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
The foregoing instrument was subscribed and sworn to me by Jerry Arthur
Layton, Trustee of the Jerry Arthur and Lena Mae Living Trust, dated February 2,
1996 this /3j day of September, 2010
Witness my hand and official seal.
Jer t Arthur Layton,/l'rustee
/i. /e
Notary Public
6 l
GLORIA K. BYERS
County of
Lincoln
M y Commission Expires September 1
NOTARY PUBLIC
�a
State of
Wyoming
RECEIVED 9/20/2010 at 12 :24 PM
RECEIVING 955593
BOOK: 753 PAGE: 877
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
CERTIFICAT RECORD r
IO��ITAL
Date filed
;'NAME AND ADDRESS OF FUNERAL FACILITY
COLTRIN MORTUARY, IDAHO FALLS, IDAHO
DATE OF INJURY,
OCTOBER. 07, 2009
LOCATION WHERE INJURY OCCURRED
DESCRIPTION OF HOW INJURY OCCURRED
STATE OF IDAHO
DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
CERTIFICATE OF DEATH
SEX SOCIAL SECURITY NUMBER AGE DATE OF BIRTH
FEMALE 78 YEARS JUNE 19, 1931
BIRTHPLACE PLACE OF RESIDENCE
CLEVER, MISSOURI ,SAND SPRINGS, OKLAHOMA
MARITAL STATUS AT TIME OF DEATH MME OF SURVIVING SPOUSE (If wife, maiden name) WAS DECEDENT EVER IN
U.S. ARMED FORCES?
MARRIED JERRY LAYTON NO
FATHER NAME BIRTHPLACE
GEORGE FRAZIER ARKANSAS
MOTHER MAIDEN MAME BIRTHPLACE
STELLA TROTTER I ARKANSAS
METHOD OF DISPOSITION FUNEYAL' SERVICE LICENSEE
REMOVAL FROM STATE DOUG COLTRIN
DATE OF DEATH TIME OF DEATH CITY,TOWN OR LOCATION OF OF DEATH COUNTY OF DEATH 1
OCT. 07, 2009 ;3:54 A.M. IDAHO FALLS, IDAHO BONNEVILLE
CAUSE OF DEATH (underlying cause ash Approximate Interval Between
a Onset and Death
CEREBRAL BLEED 10 DAYS`
DUE TO (or as a consequence of):
DUE TO (or as a consequence of):
a
DUE TO (or as a consequence of):
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting in he underlying cause given above WAS AN AUTOPSY
PERFORMED?
NONE STATED NO
MANNER OF DEATH NAME OF CERTIFIER TITLE
NATURAL ROBERT L. CACH, M.D. PHYSICIAN
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
TIME OF INJURY.
PLACE OF INJURY
J
r /i r T hi s iska t r true anc� co reproduction of the document officially registered and placed
S `�tf ofiffIle With Me IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS.
qd PER) ciN
',7 OCTOBER 07; 2009
O� DATE ISSUED: C 0.
411' This copy is not valid unless prepared on engraved border JANE S. SMITH
I!=
displaying state seal and signature of the Registrar. STATE REGISTRAR
State File No
2009 -08114
INJURY AT
WORK?
MW
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