HomeMy WebLinkAbout956026STATE OF WYOMING
COUNTY OF LINCOLN
I, Lori Ann Galloway being of lawful age and first duly sworn according
to law, upon my oath, depose and state:
COUNTY OF
LINCOLN
MY COMMISSION EXPIRES OCT. 24, 2012
SS.
AFFIDAVIT TERMINATING ESTATE
RECEIVED 10/18/2010 atJ-OS A,M
RECEIVING 95601u
BOOK: 755 PAGE: 463
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
1. That 1 am of adult age, a resident of Afton, WY 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 _638 PR on page _882 is recorded a
Warranty Deed. The Warranty deed, dated the _26 day of _October,
2010_, conveys unto Kirt R. Galloway and Lori Ann Galloway, as
Husband and Wife as tenants by the entireties the following described
property, to -wit:
Lot 17, Block 36 of the Glen Kennington etal Addition to the Afton,
Wyoming Townsite, Lincoln County, Wyoming, as described on the
official plat thereof.
3. That said Kirt R. Galloway died on the 1st day of
_September 2010, 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 "A
4. That by reason of death of said Kirt R. Galloway
FURTHER AFFIANT SAYETH NOT.
Dated October 11, 2010
State of Wyoming
)ss.
County of Lincoln
The foregoing instrument was subscribed and sworn to me by Lori Ann
Galloway this 11 day of _October 2010.
Witness my hand and official seal.
JARED B. GLEUE NOTARY PUBLIC
STATE OF
WYOMING
My Commission Expires:
by reason of 2 -9 -102 W.S. (1980), the decedent's interest and title in said
conveyance has terminated and title to the real property conveyed thereby
has vested absolutely in Lori Ann Galloway
continuously since the death of the said decedent.
42/4._
and
Notary Public
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
'Date of Death:
City of Death: Afton
Location: 286 E. 7th Ave.
Additional Decedent information
Dutch John, Utah
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:
Facility:
Other Significant,
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
STATE OF WYOMING
,Afton, 'Wyoming
Marrie Lori Ann Ariglesey
Yes
Richard lrvine,GallowayJr.
Myrna Kunz
Lori Ann Galloway
Burial
Afton Cemetery, Afton, Wyoming
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Schwab Mortuary, Afton; Wyoming
Natural Death
ry� This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming
C DATE ISSUED: Wednesday, September.15, 2010'
This copy:a not valid uples on paper with nn ordeg:
State File Number:
Social.Securi.ty Number:
Age at the Time of Death:
Relationship:
Cause; of Death:
The immediate cause is listed on the first line by arty underlying causes.
(a) Neuroendocrine Carcinoma
Physician i
Donald J. Kirk, M.D.
122 Petersen Pkwy Suite °4, Thayne, Wyoming, 83127
September 14, 2010
1
Gladys K. Breeden
Deputy State Registrar
O 4G4
2010- 002781
Wife
WTI
CERTIFICATION OF VITAL RECORD