HomeMy WebLinkAbout957865STATE OF WYOMING
COUNTY OF
I, Alan Lance Allred, 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 Thayne, Wyoming, and the Affiant
herein.
2. That said Enid White Allred on the 7th day of December, 2010, 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 "A
3. That by reason of death of said Enid White Allred by reason of 2 -9 -102
W.S. (1980), the decedents interest and title has been terminated
FURTHER AFFIANT SAYETH NOT.
Dated 20
State of Wyoming
County of Lincoln
The foregoiii-g instrument was subscribed and sworn to me by Alan Lance
Allred this 28 day of January, 2011
Witness my hand and official seal.
My Commission Expires:
AFFIDAVIT TERMINATING ESTATE
SS.
9 /5
Alan Lance Allred
Notary Public
00b1565
GLORIA K. BYERS
County of
Lincoln
NOTARY PUBLIC
State of
Wyoming
My Commission Expires September 15, 2011
RECEIVED 1/31/2011 at 12:46 PM
RECEIVING 957865
BOOK: 761 PAGE: 565
JEANNE WAGNER
LINCOLN COUNTY CLE UIMERER, WY
Decedent:
Name:
Gender:
Date of Birth:
Enid White: Allred.;
Male
May 07, 1919
Date and Place of Death:
Date of Death: December 07, 2010
City of Death: Afton
Location: Star Valley Care Center 120 Hospital Ln
Additional Decedent Information:
jDEFARTMENT OF HEALTH
CERTIFICATE OF. DEATH
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Dispositio
Method of Disposition: Burial
Place of Disposition: Fairview Cemetery, Fairview, Wyoming
Funeral Home or Facility:
Facility:
Fairview, Wyoming
Afton, Wyoming
Divorced
No
Eiden Pratt
Amy Leola White
Alan Allred
Schwab Mortuary, Afton, Wyoming
State File Number:
Social Security Number:
Age at the Time of Death:
County of Death:
Relationship:
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) Congestive Heart Failure
(b) Chronic anemia
(c) Vascular dementia
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name
Address:
Date Filed:
Natural Death
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUED: Thursda y, December 16, >2010
This copy is not valid unless prepared on paper with an. engraved border.
Physician
Christian M. Morgan, M.D.
110 Hospital Lane, PO Box ,579, Afton, .Wyoming, 83110
December 15, 2010
2010- 003867
91 years
Lincoln
..4...A
Gladys K. Breeden
Deputy State Registrar
CERTIFICATI ITAL RECORD