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AFFIDAVIT
I Ruth Ann Miller Kennington, being duly sworn on oath, depose and say:
That I am a citizen of the United States of America and over the age of 21
years, and a resident of Layton Utah.
That I was well and personally acquainted with Mary D. Miller as described in
that certain Warranty Deed dated March 23, 1962 and recorded April of 1962 in
Book 53PR page 532 of the records of the Lincoln County Clerk.
That I know of my own knowledge that Mary D. Miller in the above described
Warranty Deed and mentioned in the attached Certificates of Death were one
and the same person.
This affidavit is intended to terminate the life estate of said Mary D. Miller in
the following. Described Property:
Beginning at a point which is the Northwest Corner of Lot Number Three(3) of
Block number twenty -one (21) in the Town of Afton, Lincoln County, Wyoming
Townsite and running thence South four rods, thence running East 10 rods,
thence running North four rods, thence running West ten rods to the point of
beginning.
Dated this l' 7 day of March 2010
NANCY PEARCE
Notary Public
State of Utah
My Commission Expires February 13, 2012
910 N Fairfield Rd., Layton, UT 84041
CO 811.
Ruth Ann Miller Kennington
The foregoing instrument was acknowledged before me by Ruth Ann Miller
Kennington this J -day of March 2010
Notary Public
RECEIVED 10/1/2010 at 4:11 PM
RECEIVING 955802
BOOK: 754 PAGE: 811
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
1 PLACE OF SWATH
c. COUNTY Saline 4 4G J
2. YWAL IMOMMME (#AwoMrr ,Moat. 11f0,Mhamor Mitonri/Irsaimooms)
a. STATE Nebraska Seward
Seward
D. CITY TOWN,
rr ie d
t• LENGTH OF STAY NO 16
2 yrs.
e. CITY. TOWI.Olt LOCATION
Seward
d. NAME OF not in hospital. Ott *trod address)
NSTITUTIC�+�Qq�� arren Men. Hospital Annex
4. STREET ADDRESS
1166 6 Wh.
t. IS PLACE OF DEATH $SIDE CITY LIMITS? YES (ZMO 0
e, 15 RESIDENC *SW CITY' LIM17S1 Mg 1 f; FARO T YU
3. NARK OF Ara Ma l m.
tp print) Mary Dewey Miller
4- ORTE Mama Daa 2
MTh Doc. 1 1964
5. sEx
re e a le
6 RACE
w` i e
7 MANi11E0 0 NEVER MAR DATE OF MRTH
*IOowe C.
26,1i79
1 AtIE lti/
IF NOGG 1 �tIEI�t
a
I Jae. Itrf....
10.. USUAL OCCUPATION (Dist kindofsoork4..
twine mot N workiaLlife, sun if retired)
2,0 housewife
106. KIND OF NISMIESSORNIOUSTRY 11. MRTIIPLACE' talk or *OM paaltO
own hone Deveyville Utah
mows aEtlrO> rt
USA
13a. FATHER'S NAME
John Cyrus Dewey
13Y. MOTHER'S MAIDEN NAME
Annie Rawson :bald I
14. maw O OltISOMIO 0* INIFIE
John Geddes Miller
15. WAS DECEASED EVER
(YM, w.., rn,kM..)
M U. S. ARMED FORCES
1 al M.. ti.< M *Ai •I' awn*/
ns
M. saCwM, SECURITY No.
140a0
17 MMOMMYlT Aiiws
Mrs. Louis Sahn,Bovard, .br
g
V
23a
M. CAYli Or SEAM (Eater oil ewe CROW (t,}. (N. 1114 .1
PART 1: DEATH WAS CAUSED 0Y: if ONOMISON
IMMEDIATE CAUSE (a) w A 0 a r
r,
j t li
ebeee ,le
wa
stating tk owlet-
WIN The M t.
2,1
DUE TO (6)
DUE TO (c)
TART U. OTHER Somme CONOITIDIK ougoellunn 1O OEM OW NOT OluTurio 11E NOMEL MOM COMM OMEN M WET NO OM MOW
200. ACCIDENT SUK10E Hom1C=DE
286. DESCRM)E How $JURY OCCUIMEO. (!Mw where of 1*,, is halt r- Jeer rly ilto. .4.3
20e TIMt of Hoar Mouth. Dar, Year
INJURY a.
p. IR.
201. INJURY OCCURRED
WHILE AT NOT *NILE Q
WORK` AT WORK
28e. PLACE as MJURY (e. S, M M elfrt Wu.
la►#. 11. ONO. WIN R.)
if OTT. 700*. OR LOCRTIOM aDw1T 001,0E
�II�
21. 1 attended eh. doc aaod an M .Ili Asst r A► AMA!
aer4,Wt asv M I t
occurred at ay al Ow daft Ott Meow awl** CU 0010 al My IboIIM1 IRO.aI101srtraAOl
T TOM Mora
0 ..r .A. na` dill
1 CA1NA41ow.
/2/64
M MW )1011. MOWS
Friend
ne. RARE OF ;I°MEIVET OR MEN*
ME
tiro
LOCET0* Meet. estafte
ett,l e
24. DATE RECD. 6Y REGISTRAR
1 c ii-.
REGISTRAR'S S40NA'too
11 ODE OF, IAAT F
rre's �era1
BIRTH NO. 126
STATE OF NEBRASKA
WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTH AND
HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON
FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL RECORDS
OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
DATE OF ISSUANCE
SEP 2 9 2010
LINCOLN, NEBRASKA
PHS- 798(VS) REV. 4 -57
DEPARTMENT OF PUBLIC HEALTH,
EDUCATION AND WELFARE
STATE OF NIEDIRASKA
DISPAZISIENT OF REALTH
Severna at Vital Statiotias
CERTIFICATE OF DEATH
ad 66,
STANLEY COOPER
ASSISTANT STATE REGISTRAR
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
e00812
84 146 #3