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Home My WebLink About955803STATE OF WYOMING COUNTY OF LINCOLN SS. AFFIDAVIT TERMINATING ESTATE I, Florence K. Heiner, 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 422PR on page 556 is recorded a QuitClaim Deed. The QuitClaim Deed, dated the 7th day of December, 1998 conveys unto Morris W. Heiner and Florence K. Heiner and their successors, Trustees, of the Morris W. Heiner Family Trust dated the 23 day of June, 1998, the following described property, to -wit: 3. That said Morris W. Heiner, Trustee on the (p day of G` OD y, 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 Morris W. Heiner, Trustee by reason of 2 -9 -102 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 Florence K. Heiner, as sole Trustee, continuously since the death of the said decedent. FURTHER AFFIANT SAYETH NOT. Dated E Ig w aofo State of Wreittirtg County of 477mtehr9 )ss. The foregoing instrument was subscribed and sworn to me by Florence K. Heiner, Trustee of the Morris W. Heiner Family Trust, U/D /T dated the 23 day of June, 1998, this day of September, 2010 Witness my hand and official seal. See Exhibit "A" My Commission Expires: NOV. d 2 2 RECEIVED 10/1/2010 at 4:15 PM RECEIVING 955803 BOOK: 754 PAGE: 813 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY Florence K. Heiner, Trustee "'Notar Public JESSALYN GARRETT Notary Public State of Utah My Commission Expires Nov. 10, 2012 LOCAL FILE NUMBER STATE OF WYOMING,, DEPARTMENT OF HEALTH CERTIFICATION OF VITAL RECORD STATE OF *WINO OF HEALTH CERTIFICATE OF DEATH This is a true and exact reproduction of the document on file in the office of Vital Records Services, Cheyenne, Wyoming. STATE FILE NUMBER 1, DECEDENT'S LEGAL NAME (include AKA's do AKA's it any) (First, Middle, Las 2 1 600 3. DATE OF DEATH (MO/DOy/Vr) (Spell Mon(h( MORRIS WOLFLEY HEINER MALE. DECEMBER 6, 2004 A SOCIAL SECURITY NUMBER 50.000 Lasl81,hday 55. UPIDE111 YEAR So. UNDER 1 DAY 6. DATE OF BIRTH (MOIDey,YI)'' (Veers) Months Days Hours 0560(60 76 SEPTEMBER 28, 1928 7a. PLACE OF DEATN:(Chop1 only qne) IF DEATH OCCURRED 18990511)101 IF DEATH OCCURRED SOMEWHEREOTHEK THAN AN05PITAL 0 Inp8Venl 0 ER) Dulp0(001 CI 00A O Monaca Facility O N m(: rsIng:Hpme Long ToCo8 FOWl(y Deoode 1 s Hbme D Other (Speclly) 7b. FACILITY NAME (11 n61 10660(100, give 8110.( and number) 70. CITY TOWN, OR 0010001108 OF DEATH 7d. COUNTY OF DEATH 2752 COUNTY ROAD 122 THAYNE LINCOLN 8. BIRTHPLACE (City and 510(0 Or ldrNgn country) g, MARITAL STATUS AT TIME 00066TH 10 SURVIVING SPOUSE (11 0600 gw Oom prior 10 11161 0101,01898) ,y BEDFORD WYOMING 6Man ed ,Maned but separated Dwdow.d 00.0001.0 i7Na„arMSnae Dyn, ,�wn FLORENCE KELM S. 11. EVER IN U, 120. RESIDENCE STATE 12b COUNTY 120 CCTV TOWN OR LOCATION „ARMED FORCES, WYOMING J LINCOLN THAYNE Pl' ES ONO izu. S A:uJ ivUhwc++ 12 7 PCODi 121 OISIDECITY,LIMITS? 2752. COUNTY ROAD 122 8312..7 OYES BIND 13, FATHER'S NAME (505), Middle, Last) 14. MOTHER'S NAME 08(00 TO FIRST MARRIAGE (First, Mlddle, Last) .ROBERT CHARLES HEWER SYLVAWOLFLE.Y,. 158. INFORMANT'S NAME 150. RELATIONSHIP TO DECEDENT ;1 :15c MAILINGA00RESS ($00.10001)1 mbAJ, City; State, zIp Code) "FLORENC'E HEWER SPOUSE ;R `2752'GOUNTYOAD 122 06. METHOD OF DISPOSITION 170. PLACE OF DISPOSITION (Name 01 17b. LOCATICk- CITY OR TOWN AND STATE Burial Donation O R 086Vl61 WyWyoming Ivry or crematory) yJ Oammallon D Enl,mumem Dane BEDFORD CEMETRRY -BEDFORD, WYOMING 100.0108910600 F 110 E 1 86LICENSE NO. '19a: NAME OF FAOSITY ;19b. ADI3RESSOF FACILITY (0(05 g0gtJ 6 EM SCHWAB M0RmARY: 44EAST FOURTH'AYE. AFTON 20. ACTUAR PRESUMED TIME OF DEATH 21. DATE PRONOUNCED DEAD (Ma0ey/Vr) 22. TIME PRONOUNCED DEAD 23': WAS CORONER CO X3'30 DECEMBER 6, 2004. 13.30 CAUSE OF DEATH 24. PART I. Enter r(0 chain 01 evOn16 7900609, in'rylie of cMlp))5(01ns -lbat 7,05(19 caused lhn 408)0. 00 801 enter terminal events' such 0 00,90/ A 910810018 interval: 1,051,,OSpirel01901,801, or vent, Ular iib,iIle(ion.0110 001 80 5010 9 the etiology DO NOT ABKREVIATE Enter only One cause ona1,8 .Add add mat Imes Onset(0death IMMEDIATE CAUSE (Final disease 60ae or L r--0,41. n r� 0.4. V condition m0011m9In dooIhl DUE TO'(0r as nsequenco 6)) SoquenhaIIy list dill Barry, /A• loabn9l01h0 came Wad On Im08 b ,(L/,1 vy y Enter the UNDERLYING CAUSE SSA ^Y Li I (9.6009,. or Injury Mar m0181021110 DUE TO(or898 consequence oh' I events i08ull ng in 0.0110 LAST. i. c. DUE TO(or u a56cens0g0ee oh: PART II. Enter olh,,.65 (l oanl oondi(Iuns contributing 10000Th 5011001 resu669111150 4nd8rN ng :VY0 0580 n Pod 1 I 25. WAS AN AUTOPSY PERFORMED? DYES C3N0 26. WEREAUTOPSV FINDINGS AVAILABLE TO COMPLETE THE CAUSE OF 020791 27. DID 7086000 USE CONTRIBUTE TO DEATH? O vas `O NO O YFS NO L.4:00090BLY O UN)1NOWN 26: 10 FEMALE AGED 1054.:',. ..i. c» :Tu O Not pregnant within past year O 801 9169 ant, but pregnant 4: days m 1 year be,ore 0.010 *0 Natural 0 Homldde O Pregnant 1,1 (.me of 9.015 0 Unknown 91 pregnant 01(50 (08 pool 0001 0 AoclOBnl 0 Pending in a Riga.. 010,1/ 9 541 or097anlw,d1002 days 0'989195 OS1imde OCoLlf not bedetermined 30. DATE OF)NJAAO(MOIDaWY,) 31. TIME OF INJURY 32. PLACE OF INJURV.:(O600denI s h0 ebnslnrd( .116. lUr0e1, 60) 33,' INJURY AT WORK O YES ONO 34. LOCATION OF INJURY (800,1800 number, Cily Or Town, Stale) 35. IF TRANSPORTATION ACCIDENT, SPECIFY: O Driver l Operator O 00170909.0 D PoSSegge 0.00161 (89,5110)_ :38. DESCRIBEI(OWINJURY. OCCURRED, AND IF TRANSPORTATION INJURY. THETY PE(S)OFVEHICLE(S( INVOLVED (AUI Obll;'; pickup 01001 mi 979.59500118; etc.) 370. CERTIFIER (Check only One) JD PHYSICIAN' -To Ih0 boot 61 my knowledge, 000(0 occurred al the 1 da(0:2nd:plaOe, awl due 10 the 000,5(8) and ma cabled. O CORONER -.On 1h basis of examination, e 0C/ y f p 0 00690 t Pt e( the ti dw and 05. 91 d d jP Iha cause() 'and man0er slated Signature 0) Cmd11br 375. DATE CERTIFIED (MODay 11 375. NAME, TITLE AND ADDRESS OF CERTIFIER (Type o1 9700 i�1V 0 D PERKES MD .110 HOSPITAL LANE ;AFTON, WYOMING'83110 :350 REGISTRAR'S", 6 /1 38b. DATE RECEIVED BY REGISTRAR (MNDeytir) Note E: Luclhda McCaffrey Deputy ^State Registrar This copy is not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar. Parcel No. 1 (Home Place): Parcel No. 2 (Willow Creek): Together with appurtenances. EXHIBIT A 055 2 U0 pool( 2 I'IC DACE 55G QUITCLAIM DEED KNOW ALL MEN BY THESE PRESENTS, That Morris W. Heiner aka Morris Heiner and Florence K. Heiner, aka Florence Heiner, husband and wife, of Thayne, Lincoln County, Wyoming, in consideration of the trust created herein and for the other covenants contained herein convey and quitclaim unto Morris W, Heiner and Florence K. Heiner and their successors, Trustees, for the uses and purposes set forth in the Morris W. Heiner Family Trust between Grantors and Trustee, dated the 23rd day of June, 1998, Morris W. Heiner and Florence K. I leiner, beneficiaries, all such right, title, interest, property, possession, claim and demand as they have or ought to have, in or to all the following described prernises, in the County of Lincoln, State of Wyoming, to -wit: In Township 34 North, Range 118 West of the 6 Principal Meridian: In Section 19 of said township arid Range, and S1/2SE1/4,• EXCEPTING THEREFROM the following lot or tract, to -wit: Beginning at a point 80 rods North from the Southeast Corner of said land and Section, and running thence South 9 rods, thence West 9 rods, thence North 9, thence East 9 rods, to the place of beginning; and, ALSO, In Section 30, the W1/2NE1/4, being 80 acres of land in said Section, Township and Range; and, ALSO, The S1/2NE1/4, SE1 /4NW1/4 and Lot 2, Section 18, T33N, R118W of the 6 P.M., Wyoming, and containing 160.24 acres, more or less. Also, together with that certain Easement dated the 18 day of February, 1965, and recorded March 6, 1968, in Book 82 P.R., Page 94, a perpetual right -of -way for ingress and egress on a roadway not to exceed one rod in width across the North end of the S1 /2NW1 /4 of Section 17, T33N, R118W of the 6 P.M., Wyoming. LINCOLN COUNTY, C('ERI! 9t8DEC e YIN io: I 9 MARSHA i.:%.lJ l Ef.01, WYOMING e 0855;4b8 IN WITNESS WHEREOF, Morris W. Heiner aka Morris Heiner and Florence K. Heiner aka Florence Heiner, husband and wife, have hereunto set theft hands the day and year first above written. STATE OF WYOMING ss. COUNTY OF LINCOLN The foregoing Quitclaim Deed was acknowledged before me by Morris W. Heiner aka Morris Heiner an Florence K. Heiner aka Florence Heiner, husband and wife, this day of 1998. Witness my hand and official seal. LAYNA I IAOEOIIE NOTARY PUBLIC Expiros Counly oI Lincoln My Commission Slate al Wyoming lob. 26, 2000 My commission expires: February 26, 2000. Morris W. Heiner 2 Florence K. Heiner 55 "l (Oi:p816