HomeMy WebLinkAbout9572866011019477
STATE OF WYOMING
COUNTY OF LINCOLN
)ss.
AFFIDAVIT OF SURVIVORSHIP
00a212
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 Las Vegas, 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 ZAP day of October, 2010.
WITNESS my hand and official seal.
My Commission expires: 0 d j d-- I I
Leslie More louse
RECEIVED 12/22/2010 at 4:19 PM
STATE OF WYOMING RECEIVING 957286
ss. BOOK: 759 PAGE: 212
COUNTY OF LINCOLN JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
This instrument was acknowledged before me by Leslie Morehouse, this Z-(v day of October,
2010.
P
lic
Notary Public
•a
3"'►° State of
Wyoming
My Commission Expires October 12, 2011
Notary
Corey R. Miles
County of
Lincoln
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INSPTUTION Name(If not either
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„Reno, Nevada
CERTIFICATE OF DEATH
STATE FILE NUMBER
7.b,UNDER 1 YEAR. 7 0. UNDER 1 DA' S. DATE of BIRTH (Mo/Day/Yr)
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MOS I DAYS HOURS I 'MINS
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if:/e. INfORMANT otleript) I' I8b. mAiuktpADDRES.,:(Strpet:orR.F.Rpp,City orTown, State,Zip)
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19a BuLRIAL, cfRENtkpow,PErtnoyAL,:;prtItFt(spdoify),: 1913::;.'CMETERTOR::qREMFORY 1?n LOCATION ':!pity or TOWn? State::
Removal from State A
I :::1 Afton Cemetery
Ityyortling
20a. FIJNERALDJECTOR. SIGNATURE (Or Person Acting as Such) 20t1 FUNERAL 20c. NAME'''AND•ADDRESSOF FACILITY
..,:161 LAKE 1.1(MAIE i DIRECTORtICENSE Rossi Burke and Kr.io13el.Mortoary Reno
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TRADECALL NAMEAND ADDRESS;:;'
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-2 2 tDa date and place and due to the cause Sj Stated. (SiDriature 8,Title)
ti 4 -ELLEN OLL,•,..CLARKPAW.',.;::::,.. SIGNATURE AUTHENTICATED'
22b DATE SIONED ,22c. HOUR QF DEATH
••••P 'Z. SePtelllbOr 19, 2Q07 :i' II:i.j' ,:i'.. :ii:,: i'
w 22d PRONOUNCED DEAD (Mo/Day/Yr) 22e. PRONOLINCED:DEAOiAT (Hour)
I- a September 1007: 14:•45:
23a N ADDRESS OF C ffr(FIER:PNYSicIAN',.airEN0 PtYSICIAttri'MEDIcAL EXAMINER:iCiRTORONER) (TYP,or:Pritit: 23b LICENSE E
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24a RECISTRAR (Signatprei' i': LAURA DANIELS
24O:iDATE RECEIVE9itY REGISTRAR :'ic pENFI-1 ppE.: 0 90MOIDN!.9ABLE:DISEASE
SIGNATUR (Mo/DaY1Yr)... September 20 2007 El NO
Interval between onset and death
216.7d the best Of:inVhowledga beet:Wed at the time;tate pladeand:dcle
tgihe cause(s)stated. (SI9Datura8rTitIe)
(mo/DaYIYA 121c.:HOUR QF DEAT
2101 NAME OF ATTENDINO OTHERTHAN CERTIFIER
(type or kilt)
a'
E 21P, DATE. SIONEI
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..i..:11. ,...]ii ,i: i Yes ei No) TO:C00NER (Specify Yes
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28d. DESCRIBE HOW INJURY OCC(JRRED.•
Pilot cif aircraft (jet) •thattrashOd
2aa. Acciauicipe, Hom4:.■./Nper.,...::::' 28b PATE OF INJURY (Mo/Day/Yr) 2Ec. HOUR OF INJURY
OR PENDlisidAVEST. (Spedfir'''
ACCIDENT §epternbet13,..2007 1445
25e. INJURY AT WORK (Specify 2E31 Pl,ACE::OF:•IN4RyAc home farm street feetory, office
Yes o(No) Ndi buildifig, etc.(Spec)fyY .;:;:Aiitpori
1Sit STREET AND:NUMBER'
425 WBSt
17MOTHER NAME (First Middle Last 'Sulfa()
SEEKIN8
3a. COUNTY OF DEATH:
ifi CITY
LIMITS ?Specify Yes or
Noffi!:: Yes
289 LcteNtittN,.....,..• CITY DR TOWN STATE
4595.:Teas AVenuC: ;.:1• Reno Nevada
COMPLETION OF
C E R T I F IE R
ItIFIA
STATE REGISTRAR
CEKTIFIED COPY OF VITAL RECOADS::
This is a true' Ad exact reptdduCtion of theICCumelit officially registered and
.,p)aced on file Mtlie off State Registrar aDd:Vttal Records,
Vp
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ANY AT TFR ATTONT flTt F.R ART IRE VOIDS TT-TTS CF.RTTRCATE /IN\P°A.4 °17'111
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