HomeMy WebLinkAbout955723STATE OF WYOMING
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COUNTY OF UINTA
AFFIDAVIT OF SURVIVORSHIP 000476
Ramona Rae DeGraw, first duly sworn, upon oath, deposes and says:
1. On the 13 day of February, 2010, my father, Albert Hoffman, also known as
Albert Blaine Hoffman, died at Pinedale, Sublette County, Wyoming. Attached is a copy of
the official Death Certificate of Albert Hoffman certified to by the Vital Records Services,
Division of Health and Medical Services, Wyoming Department of Health and Social
Services, the public authority with which the original Death Certificate is of record according
to law.
2. At the time the time of my father's death, he owned certain real property with
his wife, Betty L. Hoffman and myself, as joint tenants with full rights of survivorship, said
real property being situate in Lincoln County and State of Wyoming and described as
follows:
The northerly fifty feet of the lot numbered one, of the block numbered
nine, in the Town of Kemmerer, in the County of Lincoln, in the State
of Wyoming, as surveyed, platted and recorded, and more particularly
described as follows, to -wit: Beginning at the northwesterly corner of
said lot one, running thence northerly along the northerly line of said lot
one, distance of one hundred forty feet, to the westerly alley line of said
block nine, thence at right angles, southerly along said alley line fifty
feet, thence at right angles westerly one hundred forty feet to the
westerly boundary line of said lot one on Cedar Avenue, thence at right
angles along said boundary line on Cedar Avenue, fifty feet to the point
of beginning, being a rectangular tract of ground fronting fifty feet on
Cedar Avenue and extending to the alley of said block nine, one
hundred forty feet, and containing an area of seven thousand square
feet, together with all improvements thereon.
3. Said real property was originally conveyed to Albert Hoffman, Betty L.
Hoffman and Ramona Rae DeGraw, as joint tenants with full rights of survivorship, by
Warranty Deed dated October 15, 2009, and recorded in the office of the Lincoln County
Clerk and Ex- Officio Registar of Deeds on October 19, 2009 in Book 734, Page 130.
RECEIVED 9/28/2010 at 10:05 AM
RECEIVING 955723
BOOK: 754 PAGE: 476
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
4. By reason of the death of Albert Hoffman, Betty L. Hoffman and Ramona Rae
DeGraw became the owners of the above described real estate as joint tenants with full rights
of survivorship on February 13, 2010.
Ra
AFFIDAVIT OF SURVIVORSHIP
Page 2 of 2
ona Rae DeGraw
if.A.c. l9.c.6
SUBSCRIBED AND SWORN to and acknowledged before me by Ramona Rae
DeGraw, this 24 day of September, 2010. Witness my hand and official seal. My
commission expires: /00ii LVJ, p'Z /0
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1 :00477
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Albert Blaine Hoffman
Male Social Security Number
Gladys K. Breeden
Deputy State Registrar
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Deaths
Date of Death:
City of Death:
Location:
Additional Decedent Information:
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
448623
art i
1i CERTIFICATIO ITAL RECORD
July 16, 1927
February 13, 2010 County of Death:
Pinedale
Sublette Center Inc. 333 N Bridger Ave
Randolph, Utah
Big Piney, Wyoming
Married Betty Louise Buckley
No
Albert Leroy Hoffman
Effie Rose Hayward
Ramona Rae DeGraw
Burial
Plainview Cemetery, Big Piney, Wyoming
Covill Funeral Home, Pinedale, Wyoming
Interval:
6 Months
1 Year
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) Congestive Heart Failure
(b) Tricuspid Insufficiency
Natural Death
Physician
Darcy Turner, MD
630 Piney •Dr, Big Piney, Wyoming, 83113
February 22, 2010.
This is a true certification of the document on file in the office of Vital
i0 Records Services, Cheyenne, Wyoming.,
DATE ISSUED: Wednesday, February 24; 2010
This copy is not valid unless prepared onn paper with an engrayed:border:
Age at the Time of Death:
Relationship:
Time of Death?
2010- 000439
82 years
Sublette
21:00 (Actual)
I
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