HomeMy WebLinkAbout958292L
J
6011019716
STATE OF WYOMING
SS.
COUNTY OF LINCOLN
AFFIDAVIT TERMINATING ESTATE
I, Terry Guyette, being of lawful age and first duly sworn according to law, upon
my oath, depose and state:
RECEIVED 3/1/2011 at 11:03 AM
RECEIVING 958292
BOOK: 763 PAGE: 202
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
1. That I am of adult age, a resident of Lincoln County, Wyoming, 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 is recorded a Quit Claim Deed in Book 353PR on page 210.
The Quit Claim Deed dated the llth day of June, 1994 conveys unto
Agnes Guyette, Terry Guyette, and Tina Murphy, the following described
property, to -wit:
See attached Exhibit "A"
3. That said Agnes Guyette aka Agnes Amelia Guyette died on the 28th day
of June, 2010 and a copy of the original certificate of death, certified to as
true an correct by public authority hi which the original of said certificate
is a matter of record, is attached hereto as Exhibit "B".
4. That by reason of death of said Agnes Guyette aka Agnes Amelia Guyette
and by reason of 2 -9 -102 W.S. (1980), the decedents interest and title in
said conveyance has terminated and title to the real property conveyed
thereby has vested absolutely in Terry Guyette and Tina Murphy
continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
Dated A-9-4r
Terry G ryette
My Commission Expires: o e���
State of Wyoming
)ss.
County of Lincoln
The f regoing instru was subscribed and sworn to me by Terry Guyette
this day of ruuyy 2011
Witness my hand and official seal.
Notary Public
LINCOLN
Ply Commis s :an Expires Feb 26, 2011
00 0202
LORI KALAN NOTARY PUBLIC
COUNTY OF STATE OF
WYOMING
Decedent:
Name: I
Gender:
Date of Birth:
Other Significant
Conditions:
Manner of Death:
Date and Place of Death:
Date of Death: June 26, 2010> County of Death:
City of ,Death: Riverton
Location: Wind River Healthcare Center 1002 Forest Dr
Additional Decedent Information:
Place of Birth: Kemmerer, Wyoming
Residence: Riverton Wyom ng
Marital Status: Widowed
Armed Forces: No
Name of Father: Joseph Sim Miller 4
Name of Mother. Fae'Butler
Informant: Tina Sloan Relationship:
Disposition:
Ithod of Disposition Burial
ce of Disposition: Viola Cemetery, La Barge, Wyoming
Funeral Home or Facili
Facility:
Cause of Death:
The immediate cause is listed on the first line followed: by any underlying causes.
(a) Alzheimers
Certifier:
Type: Physician
Name: Malachi Miller, M.D.
Address: 745 Buena Vista Dr, Lander, Wyoming, 82520
Date Filed: July 06, 2010
S
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Agnes Amelia_. Guyette
Fernaie
March 12, 1921
Davis Funeral °Home, Riverton, Wyoming
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming':
Friday, September :17, 2010
DATE ISSUED:
This copy is not 'valid unless prepared on paper with 'ae engraYe'dbordeK,
Social Security Number
Age at the Time of Death:
OO 2O3
2010- 001954
Gladys K. Breeden
Deputy State Registrar
Interval:
Time of Death: 20 :45 (Actual)
Bi L.jY,
jm��
CERTIFICATION OF VITAL RECORD
Order No: 6011019716BL
LEGAL DESCRIPTION
EXHIBIT `A.
000204
Lots 11 12 ,Block .B of the Riverview Addition to the Town of LaBarge formerly
Tulsa, Lincoln County, Wyoming as described on the official plat filed. on February 28,
1927 as Map No. 153 of the records of the Lincoln County Clerk.