HomeMy WebLinkAbout872711STATE OF WYOMING
COUNTY OF LINCOLN
I, Ronald W. Galloway, being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America over the age of 21 years, and a
resident of Afton, Wyoming
That I was well and personally acquainted with Jo Ann R. Galloway, that certain
Warranty Deed recorded in Book 143 P.R., Page 183 in the office of the Recorder of Lincoln
County, Wyoming.
That I know of my own knowledge that Jo Ann R. Galloway, in the said deed and Jo Ann
R. Galloway mentioned in the attached Certified Copy of Certificate of Death was one and the
same person.
This Affidavit is intended to terminate the joint tenancy Jo Ann R. Galloway, in the
following described property:
The E1 /2 of Lot 10, Tee -Mont Subdivision, Lincoln County, Wyoming, according to that plat
thereof filed in the Office of County Clerk, Lincoln County, Wyoming.
STATE OF WYOMING,
Subscribed and sworn to before me this
Residing in: *UP)
Commission expires: io 2m N
a 14}DAVIT
Lincoln County ss.
Ronald W. Galloway
day of April, 2Q.0_
L I�
4 L
tafy b tic
RECEIVED
IVED
LINCOLN COUNT'( CLERK
01 M'R 11 f 1 3:34
JEANk{ 'V t G
K EMME±RER
BOOK PR PAGE 61'i
Id W. Galloway.
STATE OF WYOMING
DEPARTMENT OF HEALTH
CL 1II NCR
LOCAL FILE NUMBER
1. DECEDENT -NAME FIRST
JO ANN
4. SOCIAL SECURITY NUMBER
518 -58 -8654
7. PLACE OF DEATH (Shea er1N and
70. FACEITY NA1.40 (M b MANMen, B ...a ara mreAe)
70 TEE MONT CIRCLE
R. STATE OF BETH (M nat in USA.. now cou.ky)
IDAHO
INFCIY t u)
10e. MAILING ADJ2E,1
70 TEE.,
17. FATHERS
❑Inpatient ER/ 0ugtl.i ODOA
HENRY
S0' STREET OR RF,D.
MONT CIRCLE
264. REGISTRAR
24. NAME AND ADDRESS OF CERTIFIER (PHYSIOIAN OR'CORO1ER)(7y1. a' PM/
0. D. PERKES MD.., 110 HOSPITAL LANE,. AFTON WYOMING 83110
090555
12.. USUAL OCCUPATION Ohs kW al waking ',own rktp *OW 1 120. KIND OF BuSI11EBB OR INDUSTRY al
NO HOMEMAKER
130, COUNTY 13e, CITY. TOWN OR LOCATKNR
LINCOLN AFTON
200. DATE (Ma, Oq, lye) 200. CEMETERY OR CREMATORY•NMME 204 WOCATICN CITY OR TOWN STATE
JANUARY 9.1999 BERN CEMETERY ERN IDAHO
Or P.nan AMMO Number 210 NAME OF FACILITY NNW 21e. ADORES3 Y
CHWAB MORTUARY 45 44 EA ST FO AVE., AFTON
.B1 ocart.d a end du, !S 233 On m. b..g M 0..+Aama.nd/w ti 0a, Rn my._11t1INar1 Gam Occurred
a m.11 m�: ob ra puo. a ar p a. r1HM.t Sera
220. HOUR OF DEATH 13 230. DATE SIGNED (A. 'Deb WJ 23e. HOUR of DEATH
7.4r. n M
vin CI (Smelly)
be. AGE•Laa Bkthdey
(*0)
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
LAST
GALLOWAY
S0. UNDER 1 YEAR
Morn* WN
p.Npr.kq Hoa.,d R.w.ne. q ONer (SP.oay)
T.. CITY. TOWN. OR LOCATION OF DEATH AFTON
B. MARRED, NEVER MARRIED. 10 SURVIVING SPOUSE (M WA qw m.Msn nom)
un W Ff ruvOwrFn ra...th,1
taa
°RIGBY
DUE TO (OR AS A CONSEQUENCE OFT:
0030 10(041 ABA CONSEQUENCE OF):
MARRIED RONALD .W. GALLOWAY
or MPir.lnry meet a..A, a Mart Mum UM oNy an mum u. .am An.
This is a true and exact reproduction of the document on file in the office of Vital
Records Services, Cheyenne, Wyoming.
DATE ISSUED: J
RUE S. OTHER SIGNIFICANT AN/�. M
CONOTIGNS•Cotimla e.MrMa.kla b Atom bus not Mama l e.ua BNar! In PART 1.
�O
cif) 6e 1C 7 e_`•r ry /N cxL si hl rei/►4V
2R. MANNER 00 DEATH 30. DATE OF 300. TIME OF '30..1NRRRY AT WC/R147
4 DAY. War) R*AJRY (RONET w ar no)
HOME MAKING
13d. STREET D Nt1AMER
70 TEE MONT CIRCLE
16: RACE -American Wean,
This copy is not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar.
2. SEX
FEMALE
(BIDorr'D__
3. DATE OF DEATH (Ma. Obey, rev
JANUARY 6, 1999
S. DATE OF BIRTH (M.. Dye
MARCH 12, 1949
It DAZE RECEIVED BY REGISTRAR Ms. Dsp, HJ
Lucinda McCaffrey
Deputy State Registrar
STATE FILE NUMBER
83110
74. COUNTY OF DEATH
LINCOLN
Nara, WHY; Eb. 1¢. DECEDENT'S ED4.C47pN
(Rp.ahl ?^N NOW p.d. oerrpt .11)
WHITE
14PTHER!9 NAME
MERLA
(0- 12(Cail.M. (1 or a
3
M.IMn Surname
,NELSON
23.. PRONOUNCED DEAD MOW
301. LOCATION ((Nat end Number ar Rural Retie Number. My or 100*. NOM
di Note co°!D oy 2 4TH HI
ANY ALTERATION OR OIDS TS CERTIFICATE 411
Ikffri�P tll>:S i I If Q l 9f ?.I�, x.`r ti n r `R /Mt 1, IRV