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HomeMy WebLinkAbout957885AFFIDAVIT TERMINATING JOINT TENANCY STATE OF WYOMING SS. COUNTY OF LINCOLN I, Colin K. Hincks, being of lawful age and duly sworn according to law, upon oath, depose and say: 1. Juanita Michelle Hincks, a single person of Grover, Lincoln County, Wyoming, was my daughter; RECEIVED 2/2/2011 at 9:41 AM RECEIVING 957885 BOOK: 761 PAGE: 668 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 000668 2. That by a certain Quit Claim Deed filed in the office of the Lincoln County Clerk on March 31, 2008, and filed in Book 690 on Page 714, I, Colin K. Hincks and Juanita Michelle Hincks, became owners as Joint Tenants with Rights of Survivorship of a certain property described in Exhibit "A attached and made a part hereof; 3. Title thereto vested in them continuously from that date of the conveyance as described in the above mentioned Quit Claim Deed to the date of death of said Juanita Michelle Hincks, which occurred on December 22, 2010. See Exhibit "B which is a certified Death Certificate of Juanita Michelle Hincks, attached and made a part hereof; 4. That by reason of and on the date of death of the said Juanita Michelle Hincks, Colin K. Hincks became the sole owner of said property; and 5. Affiant sayeth not further. DATED this 5/ day of 3 2011. AFFIDAVIT TERMINATING JOINT TENANCY Colin K. Hincks Page 1 of 2 SUBSCRIBED AND SWORN TO before me, Notary .1 c in and for the State and County above mentioned on this s day of 2011. WITNESS my hand and official seal. ©0(669 NOTARY PUBLIC My Commission Expires: V-11 AFFIDAVIT TERMINATING JOINT TENANCY Colin K. Hincks Page 2 of 2 KNOW ALL MEN BY THESE PRESENTS that Colin K. Hincks, a single person of Grover, Lincoln County, Wyoming, Grantor(s), for and in consideration of Ten (10) Dollars and other valuable considerations in hand paid, receipt whereof is hereby acknowledged, CONVEY AND QUIT CLAIM to: Colin K. I- Iincks, a single person of Grover, Wyoming, and Juanita Michelle Hincks, a single person of Grover, Wyoming, as joint tenants with rights of survivorship and not as tenants in common, Grantee(s), the following described real estate, situated in Lincoln County and Stale of Wyoming, hereby releasing and waiving all rights under and by virtue of the homestead exemption laws of the State, to -wit: A tract of land lying in the SEl /4NW1 /4 of Section 32, T33N, RI18W of the 6 P.M., Lincoln County, Wyoming, more particularly described as follows: BEGINNIN G at a point which is 1320.00 feet south and 1872.43 feet east from the Northwest corner of said Section 32 and running thence west, 104.56 feet; thence South 216.97 feet; thence East 296.97 feet; thence N41°34' west, 290.00 feet along the U. S. Highway 89 right -of -way to the Point of Beginning. Subject to reservations and restrictions contained in the United States Patent and to easements and rights -of -way of record or in use. Together with all improvements and appurtenances thereon. DATED thisa7'Zday of Abf(itvi 2008. STATE OF WYOMING ss COUNTY OF LINCOLN The foregoing Quit Claim Deed was acknowledged before me by Colin K. Hincks this a7 C day of Ai:Mehl 2008. WITNESS my hand and official seal. RECEIVED 3/31/2008 at 10:08 AM RECEIVING 937904 BOOK: 690 PAGE: 714 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY QUIT CLAIM DEED 000714 604; AL„ COLIN K. HINCKS NOTARY PUBLIC aD�l My Commission Expires: 1f Stoll err g' A.. CERTIFICATION OF VITAL RECORD rime OR PERMANENT OLACN INK 00 NOT USE RELY TiP?Eni FoR.. INSTRUCTIONS SEE HANDBOOKS c': ❑Married ❑;Mar separated 0 Widowed ®Divorced Never marred Unknown z, 10, EVER IN'USi: 115 ATNER`S'NAMFusl: Middle, [a 1 S5R.i., F E( FORCES COLIN KELLY HINCKS DISPOSITION PLACE OF DEATH 119 -22) :'195, IF DEATH;OGCURREO'I4< 14 HOSPITAL, 196. IF DEATH OCCURRED SOMEWHERE OTHER THAN A HOSPITAL: DATE O DEATH CAUSE OF DEATH ITEMS 32 -3B TO DE USED FOR EXTERNAL CAUSES ONLY CORONER) IF DEATH WAS DUE TO OTHER THAN NATURAL CAUSES, THE CORONER .m o de. AGE.Lasi Birthday 4b.UN0ER 1 YEAR 40. UNDER 1 DAY 5. DATE OF BIRTH (Mo/Day/Yr) pays ays Hours Minule5 o 41 (Yee,$) 09(23/1969 rn 7a: RESIDENCE STATE OR:F.OREIGN:000NTRY .W h COUNT:V YOMING LINCOLN STREET AND NUMBER 3 W 90923 HV 89 N 8, MARITAL STATUS AT TIME OF DEATH Yes 12a. MOTHER'S MAIDEN NAME (First; M LooI (ddl,, Suffix) is) No SUSAN ROSE 0 U 135. INFORMANT'S NAME (Type Or Onnl) C'OLIN;'HINCKS 14. METHOD OF DISPOSITION U- 0 1 NYN 5, PLACE'OF.DISPOSITIO.ame :a'Ma o) e al ®c ii'bn cremes ry o1M1ar place) Donation, E bmenl EAGLE ROCK C :REMATQRY- RamovN Npm Idaho 273 -NORTH RIDGE AVENUE Speo Ol09 vl IOAHOfALLS, :ID'AHq OR .83404;. 175, SIGNATURE OF FUNERAL SERVICE LICENSEE. PERSON ACTIN4TAS :SUCH ELECTRONICALLY FILED: RYAN J. REEVES 0. 401011an1 20ER /duloahem os'lan m 4 ❑HOSpIlity S n ter'care l aclity 60 Decedent's home 10 Olhe (Seedy) 20.PACILITY NAME (If cilily;9ry sweet and number) :21. C17Y, TOWN OR.LOCATION :OFOEATH, AND ZIP CODE 22, COUNTY OF DEATH EASTERN 'IDAHO REGIONAL MEDICAL .CENTER IDAHO FALLS' ID 8:3404 BONNEVILLE F 24 TIME OF DEATH 25 DATE PRONOUNCED'. DEAD IMoIDaynt) (Spell'monlh( 26. TIME: PRONOUNCED DEAD 2ah 23. DATE OF DEATH (MO/Day'l l '(speli month) December 22, 2010 27. CAUSE OF DEATH PART 1. Enter' Ih chain of evenly d Sea0Ss, IU a s compliealion6--Ihal directdirectly caused the deal!. DO NOT anise terminal evens ouch as Card ac 011091 ralary:arms) or ventricular fitshliailon wirRoukshriaripg the shSogy. DO :Not' ABBREVIATE. Enter only one cause on alne IMMEDIATE CAUSE (Final' disease oecgddlron a, CARDIOPULMONARY ARREST asulling in tlaamj D :TO( ass consec a Ssouenhaiiy lisl conditions.'RESPIRATORY, ARREST m B any. leading toWecause DUE'Tb (sir asacorisea nceo4) Q listed on line a Enlee the UNDERLYING CAUSE NARCOTIC OVERDOSE ._N LAST (disease e nls DUE TO (Or as a consequence ol), Ihal initialed IM19eV o :•esuu dee ;CHRONIC PAIN PART II. Enlel. 04!01 Sianificsnl conditions cpnlribUlln° Io d ea th bui nnliasulling in the underlyin9.oause given i44 Pan I 29. DID TOBACCO USE "30. IF FEMALE (Aged 104,9; CONTRIBUTE TO DEATH? Nol 24990a I ION dad) year Ti ❑Yes Probably Pregnant all 05 01 death Nol pregnant, bul oregnanl Unknown if pregnant within the past within 42 stays al deal! year 32;:DATE OF INJURY IMO /DsyO 33, TIME OF INJURY 3d, PLACE OF INJURY (Decedent's home teem 511591, consuucl on site, W Moll month) 12 h using home slaurant to esl: 5tc December: 22, 2010 Eslm 1 a at 051 04 oe HOME 0 Yes No 36 LOCATION'OF INJURY Sid'. WYOMING Dy County- GROVER, LINCOLN •arcode. IZ W 54,554 end Number Of Locaron BOX 92 C ?Gan I Number V 32: DESCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY, STATE THE TVPES(S)'OF'VEHICLEIS) INVOLVEDIAut b le n■GkyD mOIO,cycle ATV bicycle, etc.) 'SPECIFV'WHICH VEHICLE DECEDENT OCCUPIED, it applicable ACCIDENTAL OVERDO S E' 'TRANSPORTATION• 380, WAS 000000447 DriverdSpedator P ssen9er INJURV Peoesi,Cai, oIhe (SP oty) 389, CERTIPIER :'(Cnack only one. based :on bNlciel ceoeclly lai;lhle eedi0dele) 0PHYSICIAN' 91RHY8ICIAN 9 ADVANCED PRACTICE PR01E8 0 Ina bell 01 my knowledge, death bccuned 14114911.15 and and Eoe Io the natural co ()l a er staled O CORONER -O Iho 5 b 1 kd ?nation and/o. inveshgai on in my opinion. death occurred al the lime. dale. and place. arid. due to thecnnsets) a e a nee Mal d 'Signature and TINe 51C0141114! ELECTRONICALLY SIGNED: ::JONATHAN D. WALKER 39d. NAME, ADDRESS. ANOZIP CDDE.OF CERTIFIER (Type 04Dnn11: co MPLETE An SIGN .THE. CERTIFICATE JONATHAN D. 525 EIGHTR IDAHOYFALLS;:ID 83401 40e. REGISTRAR :'S SIGNATURE DECEDEN• LEGAL NAME (IncIude'AKA's if shy) ,(First Middle, Last; Surrxl JUANITA MICHELLE HINCI(5 IDAHO DEPARTMENT OF HEALTH AND WELFARE BUREAU OF VITAL ggpc ,F R AND HEALTH STATISTICS STATE OF IDAHO 12:50 :70ecember22,2010 Noi dreg y 1 b11I pregnen1:43 OaYs to I yeaf 4e1ore death: This is a true and correct. reproduction of the document officiallyy reggistered and placed on file with the IDAHO BUREAU OF VITAL.RECORDS AND.HEALTH:STATIS:TICS- DATE'ISSUE A A 1 O A This copy. not valid unless prepared on k gr'Med bonier 'displaying state seal ands(gnatUYe Registrar: r PBNCO Bird 07 /10 JAMES BtAYPEWTTE STil4,,E.:REGISTRAR 0006''1 CERTIFIC ATE:O:F:DEATH t0W or M 0 0 0 ,4 by E A .Art suds a9Ois win me 55 p RMl L R e NO Re ok<Ok 508 t r9 4E00 4, RSed• PRoERL N00.2' R4<0 00E oca g 2, SEX 3. SOCIAL SECURITY NUMBER FEMALE' 6. BIRTHPLAGE(CIN and 51ate. Tenilpry::er Foreign Country) SANTA CLARA, CALIFORNIA 7 6. CITY OR TOWN :GROVER Te. APT. NO. TI -ZIP CODE :831:22' 9, SURVIVING SPOUSE'S NAME (11 wil a, give melded name) 7g. IN5IDE CITY LIMITS? Vas ®'NB' 11 b. BIRTHPLACE (Slate. Tenlory or Foreign Country) IDAHO 12h. BIRTHPLAGE:(Slate, Terrilory,-br Foreign country) SOUTH DAKOTA 13b, RELATIONSHIP T,O :DECEDENT :130. MAILING ADDRESS 151ieet.and'liumber, Cily, Stale: Zio'Cddel FATHER 'BQ( 92' GROVER;:WY 03122 ddress of cemetery, '16. NAME AND COMPLETE ADDRESS OF FUNERAL FACILITY 273 NORTH':RIDGE': AVENUE 1DAHO IDAHO 83401 17b. LICENSE NUMBER IO licensee) ,4.: WAS CORONER: CONTACTED 000.70 CAUSE OF DEATH? M08:1 ❑.Res 0 N 12:50 Aoorohrnale Intehmi. Onset Io Death LESS THAN 24 HOURS 1.655 THAN 24 HOURS .LESS THAN 24 HOURS YEARS 26a. WAS.AN AUTOPSY 206, WERE AUTOPSY FINDINGS PERFORMED? AVAILABLE TO COMPLETE THE -CAUSE OF DEATH? Yes ®;.NO ❑Yes No 34, MANNER 0E: DEATH Ne1Ure1 Hom,CtdO 'AttIdent' PendingAM /esllgallnn Suicide 601410410(4190940100170* he 35. INJURY AT WORK? J6b. WHAT SAFETY DEVICES(S) DID DECEDENT USEIEMPLOY7 ❑:Seal bell '0 6had solely' seal. ©'Helmet Ai, bag None Unknown .19b. LICENbE.NUMBRR '39c DA TE SIGNE4 1 �1 /2011 AMA DD YYYY 777777 TT A ♦ITYYYRYYTFYYP YfYYVFYWYYVAYi 1 g 3 j Cy k ANY L�TERATION ERASURE VOIDS I THIS i CERTIFICATEL.1E ti 14ALI I �I LI D D ID V LID OVA I vnLl. EXHIBIT "B"