The URL can be used to link to this page

Home My WebLink About95956963371 Hickman LandT1tleCo SINCE 1904 AFFIDAVIT RECEIVED 6/7/2011 at 4:08 PM RECEIVING 959569 BOOK: 767 PAGE: 710 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY DAVID A. COHEN 000710 I, DAVID A. COHEN, being first duly sworn on oath, depose and say: That I am a citizen of the United States of America over the age of 21 years, and a resident of WYOMING. That I was well and personally acquainted with MARY JANE COHEN one of the Trustees of the in that certain Warranty Deed dated 2/5/2008 and recorded 2/6/2008 in Book 686, at Page 101, as Filing No. 936777, in the office of the Recorder of LINCOLN County, Utah. That I know of my own knowledge that MARY JANE COHEN in the said deed and MARY JANE COHEN mentioned in the attached Certified Copy of Certificate of Death was one and the same person. This affidavit is intended to terminate the tenancy of said Warranty Deed noted above. LEGAL DESCRIPTION EXHIBIT "A" Tax Roll No. 37182930805300 Dated this 2ND day of June 2011 A.D. DF 63371 STATE OF WYOMING SS County of TETON INDIVIDUAL ACKNOWLEDGMENT On the 2ND day of June A.D. 2011 personally appeared before me DAVID A. COHEN the signer(s) of the within instrument, who duly acknowledged to me that he /she /they executed the same. Commission expires:10 /11/2011 Residing in:LINCOLN COUNTY D. FENTON/ Notary Public .7i- eg©EORk C'�,n 41.PPn.6 ©ci5�tW61R. v to Y "Uhiic County of Luicoin State of 1 Wyoming v My Con mmi;aion r r 1 001/2011 aq Ctts1R1 ©N13J ;f 4 R 6 83Ne4RE71qV, 000711 DF Decedent: Name: Gender: Date of Birth: Date and Place of Death: Date of Death: City of Death: •Location: Certifier: Type: Name: Address: Additional Decedent Infor Place of Birth: Residence: Marital Status: Armed Forces: Name of Father: Name of Mother: Informant' Other Significant Conditions: Manner of Death: Natural Death Date Filed: April 19, 2010 DEPARTMENT OF HEALTH 00071;4 2010-001038 State File Number: Mary Jane Cohen Female Social Security Number August 12, 1944 Age at the Time of Death: March 26, 2010 Jackson St Johns Hospital PO Box 428 rnation: M(rIneepolis, IV!innasota Alpine, Wyoming Married David Allen Cohen No Kenneth Kelley Mary Jane Moorehouse David Allen Cohen Disposition: Method of Disposition: Cremation Place of Disposition: Vauey Mortuary Crematory, Jackson, Wyoming Funeral Home or Facility: Facility: Valley Mortuary, Jacl<son, Wyonling Cause of Death: The immediate cause is listed on the first line followed by any underlying causes. (a) metastatic bladder cancer Physician Ellen B. Meyers po Box 428, 555 E., Broadway, Suite 201, Jackson, VVyoming,, 83001 This is a true certification of the document on file in the office of Vital Statistics Services, Cheyenne, Wyoming DATE 1S$UED: Thursday;:june lo, 2010 .,This copy is not valid unless prepared on paper wnh an engraved border. 65 years 13:25 (Actual) Gladys K. Breeden Deputy State Registrar it Pr :1 CERTIFICATION OF VITAL RECORD slw •rtmg••••■•,,... EXHIBIT "A" 000713 Lot 714, LAKEVIEW ESTATES, EIGHTH FILING, Lincoln County, Wyoming, according to the plat filed in the office of the County Clerk, August 21, 2003 as Plat No. 250 -F.