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STATE OF WYOMING
COUNTY OFda
SS.
AFFIDAVIT TERMINATING ESTATE
I, Lois C. Rodgers, 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 Afton, Wyoming, and the Affiant
herein.
2. That by virtue of the conveyances which are recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming is recorded a Warranty Deed dated the day of
1993 in Book gds PR on page .3 C_3
conveys unto Scott P. Rodgers and Lois C. Rodgers, Husband and Wife,
as Joint Tenants with Rights of Survivorship the following described
property, to -wit:
Part of Section 7, Township 31 North, Range 118 West of the 6 P.M.,
Lincoln County, Wyoming being more particularly described as follows:
Beginning at a point which is 89.5 rods North from the Southwest Corner
of said Section 7 and running thence East 6.5 rods; thence South 4 rods;
thence West 6.5 rods; thence North 4 rods to the Place of Beginning.
3. That said Scott P. Rodgers on the day of
c ,O01 died and a copy of the original certificate of death, certified to
as true and 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 Scott P. Rodgers 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 Lois C. Rodgers continuously since the death of the said
decedent.
FURTHER AFFIANT SAYETH NOT.
Dated aP d a
Witness my hand and official seal.
Wm�
JILL H. LARSON NOTARY PUBLIC
County of (j, State of
Lincoln Wyom.ina
.m c KJ, it cfinet &vicfs: 6. .9 0 -9, o 1/
Lois C. Rodgers
RECEIVED 10/14/2010 of
RECEIVING 956001
BOOK: 755 PAGE: 366
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
00u366
State of Wyoming
)ss.
County of Lincoln
The foregoing instrument was subscribed and sworn to me by Lois C.
Rodgers this 9 day of September, 2010
CERTIFICATE OF VITAL RECORD
Date. Filed
DUE TO (or as a consequence of):.
b.
DUE TO (or as a consequence of):
c.
DUE TO (or as a consequence of):
d.
CAUSE OF DEATH (underlying cause
CEREBRAL INFARC
.DESCRIPTION OF HOW INJURY OCCURRED
:HO DEPARTMENT OF HEALTH, AND WELFARE
EAU O� HEALTH POLICY AND VITAL STATISTCS'
TI KATE OF DEA
DECEDENT LEGAL NAME
SCOTT RODGERS
BIRTHPLACE
SMOOT, WYOMING
MARITAL STATUS AT TIME OF DEATH
MARRIED
FATHER NAME
BERT H. RODGERS
MOTHER MAIDEN NAME
BURNICE PETERSON
METHOD OF DISPOSITION
REMOVAL FROM STATE
NAME AND ADDRESS OF FUNERAL FACILITY
SCHWAB MORTUARY, AFTON1, WYOMING
MANNER OF DEATH
NATURAL
DATE OF INJURY
LOCATION WHERE INJURY OCCURRED
SOCIAL SECURITY NUMEER
FUNERAL.SERVICE LICENSEE
BOB -M. CORNELISON
TIMEOF
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH =but noRdsulliny in the underlying cause given- above
NONE STATED
PLACE OF RESIDENCE
AFTON', W
NAME. OF SURVIVING SPOUSE (I1 uite, maiden. name)
LOIS CLARK
NAME OF CERTfRER
CLARK'H. ALLEN, M.D.
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
DATE OFBIRTH
MARCH 12, 1929
BIRTHPLACE
UTAH
CITY,TOWN OR LOCATION OF DEATH
':POCATELLO, IDAHO
WAS DECEDENT EVER IN.
US. ARMED FORCES?
NO
Approximate Interval Between
Onset and Death
72 HOURS
PLACE OF INJURY
WAS AN AUTOPSY
PERFORMED?
NO
INJURY AT
WORK?
II!b'' II rl I
This is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF;H:EALTH POLICY AND VITAL STATISTICS.
DATE ISSUED: APRIL 13, 2004
This copy is not valid unless prepared on engraved border
displaying state seal, and signature of the;, Registrar.
oY r
'4 40
JANE S. SMITH
STATE REGISTRAR
State File No. 2 0 0 4, 6.2'45 9