HomeMy WebLinkAbout9572856011019477
STATE OF WYOMING
)ss.
COUNTY OF LINCOLN
Leslie Morehouse, being of lawful age and having been first duly sworn according to law,
on oath deposes and states:
1. That by Warranty Deed dated the 1 day of September, 2005, BARRMORE, LLC
conveyed to Brad Morehouse and Leslie Morehouse, husband and wife as tenants by the
entireties, certain real estate more particularly described as follows: Lost 29 and 30 of Afton
Airpark Addition to the Town of Afton, Lincoln county, Wyoming as described on the official
Plat No. 167 -C filed August 1, 2005 as Instrument No. 910442 of the records of the Lincoln
County Clerk.
2. That said Warranty Deed was filed in the office of the County Clerk and Ex-
Officio Register of Deeds for Lincoln County, Wyoming, on the 28th day of September, 2005,
and duly recorded in Book 599 at Page 388.
3. Brad Morehouse and Leslie Morehouse were lawfully married at the time of said
Warranty Deed and were expressly designated in said Warranty Deed as husband and wife, as
tenants by the entirety.
4. That Brad Morehouse, one of the Grantees in said Warranty Deed and husband of
the Affiant, died in Reno, Nevada, on the 13 day of September, 2007, and left surviving, his
widow, Leslie Morehouse, who was named as the other Grantee in said Warranty Deed.
5. That the death of said Brad Morehouse terminated his previous estate in the real
property described in said Warranty Deed, leaving Leslie Morehouse as the sole surviving joint
tenant.
6. That attached hereto and made a part hereof is a certified copy of the Certificate of
Death of Bradley Daniel Morehouse; and that Bradley Daniel Morehouse named in said
Certificate of Death was one and the same person as Brad Morehouse named in the Warranty
Deed described herein; and that Leslie Ione Morris, named in said Certificate of Death as the
Surviving Spouse is one and the same person as Leslie Morehouse named in the Warranty Deed
described herein.
7. That this Affidavit is made pursuant to the provisions of WYO. STAT. 2 -9 -102.
8. That Affiant's interest in said Lots 29 and 30 will be conveyed simultaneously
herewith to the Bradley D. Morehouse Revocable Trust dated May 24, 2002.
DATED this
day of December, 2010.
RECEIVED 12/22/2010 at 4:15 PM
STATE OF WYOMING RECEIVING 957285
ss. BOOK: 759 PAGE: 210
COUNTY OF LINCOLN JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
This instrument was acknowledged before me by Leslie Morehouse, this a20 day of December,
2010.
WITNESS my hand and official seal.
My Commission expires: 9 /5 1
AFFIDAVIT OF SURVIVORSHIP
000219
Leslie Morehouse
awa..) /2y-e..72-43.
Notary Public
My Commission Expires September 15, 2011
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PRINT IN
PERMANENT
BLACKINK
DECEDENT
IF DEATH
OCCURRED IN
INSTITUTION
SEE HANDBOOK
%'S REGARDING
„COMPLETION OF
"1(ESIDICE
ITEMS
:TRADE CALL
REGI
CAUSE QF:
DEATH:
CONDITIONS:
ANYINHICH :S'
Y;AVE'RISE,TO
IMMEDIATE S'
US
CAE
STATING
UNDERLYING
CAUSE14S'r
V ASPIOE c9v DTR
ISICT HEA T DgPARTM
VITAL:STATISTICS
Reno, Nevada
;C•RTIFICATE OF DEATH
2007007243
STATE FILE NUMBER
ayiYear) 3a. COUNTY.OF DEATH
la. DECEASED -NAME FIRST
•Bradtey
Daniel
3b. CITY TOWN „OR LOCATION OF DEATH
R eno
5. RACE-(e.. ,'White Blacif
American t
kndian). (SPeci y)
Whie
9a STATE OF BIRTH :Of not U S A
name country) :Cailtomia
t
SOCIAL SECURITY NUMBER
1,50. R STATE
Wyoming
1 INFORMANT NAME(Type or Print)
>Les{Te Hine MOREHOUSE
19.0: BURIAL OREMATION,IREMOVAL OTHER (Specify)"
Removal from State
20a. FUNERAL. DIRECTOR,. SIGNATURE (Or Person Acting as Such)
B HOW
SIGNdTURE AUTHENTICATED
1b. MIDDLE lc. LAST
MOREHOUSE_:.,
3c, HOSPITAL:OR OTHER_:INSTITUTION Name(If not either; give street
and number) Reno =Stead Airport'
6 Was Decedentof Hispanic Origin? No
If yes specify Mexican Cuban, Puerto Rican etc.
Non- hisPenic:
10 .EDUCATION
15b. COUNTY
Lincoln.,
16. FATHER NAME (First: Last Suffix)
Sidney MOREHOUSE
!o the causes) stated (Signature* Title)
T1ile)
21b DATE SIGNER (Mo /DayfY.:rJ
z
m 21 NAME OF ATTENDING PHYSICIAN`IF OTHER :THAN CERTIFIER
2 ai rl
(Type or Pdt)
a
21a.HOER OF DEATH
7a AGE Last
birthday (Years).
9b. CITIZEN OF WHAT CQUNTRY
United State
14a. USUAL OCCUPATION (Give Kind •of Work Done During Most of Working
life, Even IfRefired) Developer
c. CD TOWN:_OR LQ'CATION
Afton
7b UNDER 1 YEAR
MOS I DAYS
11. MARRIED, NEVER MARRIE4, WIDOWED
DIVORCED'(Specify) AAarrrart
17 MOTHER NAME {First Middle Lest 'Suffix)
Janet SERKINS
186. MAILING ADDRESS.. (Street;or RF R No, City or Town State; Zip)
P B o�(1662 Afton W yoming 8 3110
20b. FUNERAL
DIRECTOR LICENSE
822
2. DATE OF DEATH (MofD
September 18 2007
3e If liosp or Inst. DOA OPIEm @r. Rm.
Inpatient(Specify)
7c. UNDER
HOURS
1 DAY...
THINS
15d. STREET AND NUMBER
225 West 'm
Dlaonl
19b CEMETERY OR CREMATORY NAME
Afton Cemetery
20c, NAME AND "ADDRESSOF FACILITY
Rossi •Sorkoeocl Koobel Mortpary, Reno
2155'Kletzke Lane Reno NV 89502
TRADE CALL NAME ANIJ ADDRESS
Schwab Funeral Horne 44East Fourth Afton WY 83110
z 21 a To the best of my knowledge death'o'ccurred at the time, date and place.and due
22a, On the basis of examinationand /or ihves
o the time, date and place and due to the cause
o ELLEN t,.I CLARK M.01
22b::
igation in M opinion death:cccurred at
s)' stated. (Signature &Title)
SIGNATURE AUTHENTICATED
o
C7
m o
DATE SIG (MolDayAYr)
September 1;9, 2007
122c. HOUR OF DEATH
1445
22e. PRONOUNCED DEAR AT (Hour)
o 22d. PRONOUNC DEAD (Molbay/Yr)
September 13 2007
23a. NAME.AND ADDRESS OF CERTIFIER (PHYSICIAN ATTENDING PHYSICIAN; MEDICAL EXAMINER; OR CORONER) (Type or Print):
Ellen G.I ClarkM D PO Box 11130'Renp NV 89520
LAURA .DANIELS
SIGNATURE AUTHENTICATED
25 iMMEDIAT .oAUSE (ENTER ONLX 9NE CAUSE PER LINE FOR (a), (b), AND (c).)
PART tn1
Multiple bluntfor£e'trauma
24a. REGISTRAR (Signature)
Interval between onset and death
DUE TO, OR AS ASONSEQUENCE OF:
"interval between 4nset:and death
Interval between:onset
;b) DUE TO, OR AS A'CONSEQUENCE 'OF
FART.: OTHER SIGNIFICANT CONDITIONS Condittens contributing to death but not resulting in the underlying` cause
ver n Part:1.
28a. ACC' SUICIDE HOM' .UNDEL
OR PENDING. INVEST. (Specify)
ACGIDE.
28e, INJUIRY AT WORK (Specify
Yes or No) NO
28c. HOUR OF INJURY
1445
28b, DATE OF. (Mo /D
Seplembcl 1.3.;, 2007
28f. PLACE' F O INJURY 'At home farm street f office
buii lrn9 etc :(Speify). Airport j,
Wasttoe
4.. SEX
Male
8 DATE OF BIRTH (MolDay/Yr)
October 071959
12. SURVIViNQ SPOUSE (if wife give
Maiden n mei Slle lone MORRIS
14b. KIND OF BUSINESS OR INDUSTRY
Land
IS6:::INSIDE.CITY
LIMITS (Specify Yes or
No) 'i Yes
9c. LO Cdy or Towrt State;:
Afton Wyoming 8311:(1
23b,LICENSE NUMBER
24ti' DATE RECEIVED
(MO /Day/Yr) Septe
8Y REGISTRAR 24c. DEATH DUE TO COMMUNICABLE DISEASE
rnber 20 2007 I YES d NO
26. AUTOPSY (Specify'
Yes or No) YeS
27 WAS CASE REFERRED
TO CORONER (Specify Yes
orNo) Yes
28d DESCRIBE HOW INJURY OCCURRED
Pilot of aircraft (jet) that crashed
28g LOCATION STREET DR R F D." No CkTY OR TOWN
4895;Texas Avenue Reno
STATE
Nevada::
PARENTS
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CERTIFIED COPY OF VITAL RECORDS
This is a true'an rod do
il exact repttehon of the cument offcially registered and
:::placed on file to the office of the State Reglstrnr and Vital Records
I DEPUTYRLUTSTRAR
r This coy of t vaitd unless:prepared.on:engraved border displaying dote
tIN�
F �c?�';,���y!/ /ill sA►Ir
eal a )id of Registrar.
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