HomeMy WebLinkAbout959251STATE OF WYOMING
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COUNTY OF LINCOLN
B NEUENSCHWANDER NOTARY PUBLIC
County of
Lincoln
State of
Wyoming
My Commission Expires August 31, 2014
RECEIVED 5/13/2011 at 9:58 AM
RECEIVING 959251
BOOK: 766 PAGE: 563
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
NOTARY PUBLIC
Marilyn Johns, a /k/a Marilyn L. Johns, being first duly sworn on oath deposes and say:
1. That Marilyn Johns is of adult age and is the surviving wife of Roland Johns, who
died February 5, 2011, in Montpelier, ID, as hereinafter more fully appears.
2. That by a Warranty Deed dated October 1, 1963, and recorded September 9, 1966,
in the office of the Lincoln County Clerk in and for the County of Lincoln, State of Wyoming, in
Book 75 PR, Page 431, Melba Beyeler, a widow, to Roland Johns and Marilyn L. Johns,
husband and wife, by the entireties, of HC 63 Box 86, Cokeville, Wyoming 83119, Lincoln
County, State of Wyoming, the following described real estate situated in Lincoln County, State of
Wyoming, to -wit:
That property as more fully described on Exhibit "A" attached hereto and by this
reference made a part hereof.
3. That Roland Johns died on the 5`' day of February. 2011, in Bear Lake County,
State of Idaho, and thereupon, the certificate of his death was duly filed with the State of Idaho and
made a matter of record in said office, and a certified copy of said certificate is attached hereto and
made a part of this affidavit.
4. That upon the death of Roland Johns, as aforesaid, the joint tenancy created by the
aforesaid deeds were terminated, and Marilyn Johns, surviving wife, became vested with all of her
right, title and estate in the above property.
DATED this 15 day of April, 2011
hi 0
Marilyn
P
SUBSCRIBED AND SWORN to before me by Marilyn Johns, a /k/a Marilyn L. Johns,
this 15 day of April, 2011
000563
k TY\OLV.13..)Q3.Sn
LINCOLN COUNTY, Wv0M7.1
i.esurvey Tract No U7, including the following Lots:
5, 6, 9, 10, 11, 1 2, 1 16, 18, 19, 20, 26, and 2 9
Resurvey Tract 118 and 581/4 NW1/4
Resurvey Tract No,
All in
All that part of .Eesurvey Tract No- 116 lying North and
East of a line beginning at a point on the South line of
said Tract No. 116, 955.2 feet East of Came No. 5 of said
Tract, running thence North 16 degrees 30 minutes West
581.4 feet, thence :_lorth .26 degrees 50 minutes West 534.
feet, thenCe 44 degree S 49mimuteaWest 281.4: feet!'.
thence North .54 degrees 26 minutes West 48T.3 feet, thence
North- 81 degrees =:3 minutes. West 1046.9 feet, thence North
57 degrees 59 minutes West 281.4 feet, to a point on the
West line of said 7 ract No. 116, 891.3 feet South of
Conner No. 8 of said Tract No. 116 of Section 6, Township
25 North, Range 11, West of the 6th P.M., and of Section
1, Township 25 Non, ..7.anc 120, West of the 6th P.M.,
That part of Lot lying and situate on the North and
East side of year rlivar
6 and 7 000564
6
6 and 7
25N 1
W 6th P.M.
1. 2 5N 120. W 6th P.M.
CERTIFICATIO ITAL RECO J
Date Filed
I
SIX SOCIAL SECURTY NUMBER AGE DATE OF BIRD
MALE 84 EAR S.. AUGUST 21, 1926
BIRTHPLACE PLACE OF.RESIDENCE
SMOOT, WYOMING COKEVILLE, WYOMING
MARITAL STATUS AT TIME OF DEATH NAMB OF SURVIVING SPOUSE (1/ Hire, maiden name) WAS DECEDENT EVER IN
Us. ARMED FORCES?
MARRIED MARILYN LANCASTER YES
G
FATHER NAME BIRTHPLACE
WILLIAM JOHNS UTAH
MOTHER MAIDEN MME BIRTHPLACE
VIVIAN ALBERTA STALEY UTAH
l METHOD OF DISPOSITION,
REMOVAL FROM STATE
NAME AND ADDRESS OF FUNEFAL.FACILITY
DESCRIPTION OF HOW INJURY OCCURRED
FEBRUARY 17, 2011
STATE OF` IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF` VITAL RECORDS: AND HEALTH STATISTICS
FUNERAL SERVICE LICENSEE
DAVID N. MATTHEW
MATTHEWS•MORTUARY, INC., MONTPELIER,- IDAHO
State File No 2011 01313
DATE OF DEATH TIME OF DEATH CITY.TOWN OR LOCATION O F DEATH COUNTY OF DEATH
FEB. 05, 2011 2:10 A. MO.NTPELIER,: IDAHO BEAR LAKE
CAUSE OF DEATH (underlying cause asl) Approximate Interval Between
Onset and Death
CONGESTIVE HEART FAILURE MONTHS
DUE TO (or. as a consequence o1):
b.
CORONARY DISEASE S/P BYPASS YEARS
DUE TO (or as a 000sequence at):
a
DUE TO for as a consequence 01)
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO:DEATH but not resulang In the underlying cause given above. WAS AN AUTOPSY
PERFORMED?
HYPOGLYCEMIA DIABETES BRADYCARDPA NO
MANNER OF DEATH NAME OF CERTIFIER' TITLE
NATURAL JACK O.. CI M PHYSICIAN
CORONER ':SUBSEDUENT.CERTIFICATION NECESSARY
DATE OF INJURY TIMEOF INJURY PLACE OF INJUFN INJURY AT
WORK?
LOCATION WHERE INJURY OCCURRED
This file with the IDAHOeBURE BUREAU VITAL RECORDS TH
AND HEALSTATISTICS
on
FEBRUARY 18, 2011
t 41. DATE ISSUED:
w This copy not valid unless: prepared on engraved border
71: displaying state seal and signature .of R9g(';tfa r•
PINCOEISOOMO
7 4M 4 14 L.75 q./6/(2a
JAMES B.; AYDELOTTE
STATE REGISTRAR:
•LID
IDV
V
a.
d.
CERTIFICATIO ITAL RECO J
Date Filed
I
SIX SOCIAL SECURTY NUMBER AGE DATE OF BIRD
MALE 84 EAR S.. AUGUST 21, 1926
BIRTHPLACE PLACE OF.RESIDENCE
SMOOT, WYOMING COKEVILLE, WYOMING
MARITAL STATUS AT TIME OF DEATH NAMB OF SURVIVING SPOUSE (1/ Hire, maiden name) WAS DECEDENT EVER IN
Us. ARMED FORCES?
MARRIED MARILYN LANCASTER YES
G
FATHER NAME BIRTHPLACE
WILLIAM JOHNS UTAH
MOTHER MAIDEN MME BIRTHPLACE
VIVIAN ALBERTA STALEY UTAH
l METHOD OF DISPOSITION,
REMOVAL FROM STATE
NAME AND ADDRESS OF FUNEFAL.FACILITY
DESCRIPTION OF HOW INJURY OCCURRED
FEBRUARY 17, 2011
STATE OF` IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF` VITAL RECORDS: AND HEALTH STATISTICS
FUNERAL SERVICE LICENSEE
DAVID N. MATTHEW
MATTHEWS•MORTUARY, INC., MONTPELIER,- IDAHO
State File No 2011 01313
DATE OF DEATH TIME OF DEATH CITY.TOWN OR LOCATION O F DEATH COUNTY OF DEATH
FEB. 05, 2011 2:10 A. MO.NTPELIER,: IDAHO BEAR LAKE
CAUSE OF DEATH (underlying cause asl) Approximate Interval Between
Onset and Death
CONGESTIVE HEART FAILURE MONTHS
DUE TO (or. as a consequence o1):
b.
CORONARY DISEASE S/P BYPASS YEARS
DUE TO (or as a 000sequence at):
a
DUE TO for as a consequence 01)
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO:DEATH but not resulang In the underlying cause given above. WAS AN AUTOPSY
PERFORMED?
HYPOGLYCEMIA DIABETES BRADYCARDPA NO
MANNER OF DEATH NAME OF CERTIFIER' TITLE
NATURAL JACK O.. CI M PHYSICIAN
CORONER ':SUBSEDUENT.CERTIFICATION NECESSARY
DATE OF INJURY TIMEOF INJURY PLACE OF INJUFN INJURY AT
WORK?
LOCATION WHERE INJURY OCCURRED
This file with the IDAHOeBURE BUREAU VITAL RECORDS TH
AND HEALSTATISTICS
on
FEBRUARY 18, 2011
t 41. DATE ISSUED:
w This copy not valid unless: prepared on engraved border
71: displaying state seal and signature .of R9g(';tfa r•
PINCOEISOOMO
7 4M 4 14 L.75 q./6/(2a
JAMES B.; AYDELOTTE
STATE REGISTRAR:
•LID
IDV
V
a.
d.
CERTIFICATIO ITAL RECO J
Date Filed
I
SIX SOCIAL SECURTY NUMBER AGE DATE OF BIRD
MALE 84 EAR S.. AUGUST 21, 1926
BIRTHPLACE PLACE OF.RESIDENCE
SMOOT, WYOMING COKEVILLE, WYOMING
MARITAL STATUS AT TIME OF DEATH NAMB OF SURVIVING SPOUSE (1/ Hire, maiden name) WAS DECEDENT EVER IN
Us. ARMED FORCES?
MARRIED MARILYN LANCASTER YES
G
FATHER NAME BIRTHPLACE
WILLIAM JOHNS UTAH
MOTHER MAIDEN MME BIRTHPLACE
VIVIAN ALBERTA STALEY UTAH
l METHOD OF DISPOSITION,
REMOVAL FROM STATE
NAME AND ADDRESS OF FUNEFAL.FACILITY
DESCRIPTION OF HOW INJURY OCCURRED
FEBRUARY 17, 2011
STATE OF` IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF` VITAL RECORDS: AND HEALTH STATISTICS
FUNERAL SERVICE LICENSEE
DAVID N. MATTHEW
MATTHEWS•MORTUARY, INC., MONTPELIER,- IDAHO
State File No 2011 01313
DATE OF DEATH TIME OF DEATH CITY.TOWN OR LOCATION O F DEATH COUNTY OF DEATH
FEB. 05, 2011 2:10 A. MO.NTPELIER,: IDAHO BEAR LAKE
CAUSE OF DEATH (underlying cause asl) Approximate Interval Between
Onset and Death
CONGESTIVE HEART FAILURE MONTHS
DUE TO (or. as a consequence o1):
b.
CORONARY DISEASE S/P BYPASS YEARS
DUE TO (or as a 000sequence at):
a
DUE TO for as a consequence 01)
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO:DEATH but not resulang In the underlying cause given above. WAS AN AUTOPSY
PERFORMED?
HYPOGLYCEMIA DIABETES BRADYCARDPA NO
MANNER OF DEATH NAME OF CERTIFIER' TITLE
NATURAL JACK O.. CI M PHYSICIAN
CORONER ':SUBSEDUENT.CERTIFICATION NECESSARY
DATE OF INJURY TIMEOF INJURY PLACE OF INJUFN INJURY AT
WORK?
LOCATION WHERE INJURY OCCURRED
This file with the IDAHOeBURE BUREAU VITAL RECORDS TH
AND HEALSTATISTICS
on
FEBRUARY 18, 2011
t 41. DATE ISSUED:
w This copy not valid unless: prepared on engraved border
71: displaying state seal and signature .of R9g(';tfa r•
PINCOEISOOMO
7 4M 4 14 L.75 q./6/(2a
JAMES B.; AYDELOTTE
STATE REGISTRAR:
•LID
IDV
V