HomeMy WebLinkAbout960589THE STATE OF WYOMING
ss.
COUNTY OF LINCOLN
AFFIDAVIT OF SURVIVORSHIP
I, SALLY ANN SHORTER, being first duly sworn, upon my oath depose and say:
1. That I am of adult age, a resident of Afton, Lincoln County, Wyoming, and
the Affiant herein.
2. That DEAN S. SHORTER is the record owner of the following vehicles:
a. 1929 Ford 1 -1/2 ton truck, Model AA, VIN AA1756414
b. 1963 Dodge, Model Polara 600 -642, VIN 6432- 138794
c. 1990 Ford pickup, VIN 1FTJX3562LKA43951
3. Said DEAN S. SHORTER died on the 16th day of February, 2011, at
Afton, Lincoln County, Wyoming, and a copy of the official certificate cf death,
notarized to as true and correct by the public authority in which the original of said
certificate is a matter of record, is attached hereto as Exhibit "A".
4. By reason of the death of said DEAN S. SHORTER his interest and title in
said automobiles has terminated and title to the real property conveyed thereby has vested
in SALLY ANN SHORTER.
FURTHER AFFIANT SAYETH NOT.
DATED this day of August, 2011.
SALLY A SHORTER
Affidavit of Survivorship
Page 1 of 2
RECEIVED 8/17/2011 at 10:09 AM
RECEIVING 960589
BOOK: 771 PAGE: 285
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
000285
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
SUBSCRIBED AND SWORN to before me, a Notarial Officer, by SALLY ANN
SHORTER this day of August, 2011.
WITNESS my hand and official seal.
RYSTAL L. SLAUGHTER
County cC
Lincoln
PJIy ComrnissiL
NOTARY PUBLI
State of
Wyoming
Feoruary 3, 2014
My Commission Expires:
NOTARIAL OFFICER
3 /Iq
Affidavit of Survivorship
Page 2 of 2
000286
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death: February 16, 2011,
City of Death: Afton
Location: 4231 State Highway 241;
Additional Decedent Information:
Place of Birth: Auburn, Wyoming
Residence: Afton, Wyoming
Marital Status: Married Sally Ann Price
Armed Forces: No
Name of Father: Frank Clay Shorter
(game of Mother: Delpha Sessions
Informant: Sally Ann Shorter
Disposition:
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Udean S Shorter
Male S9Cial Security Number:
December 21, 1939 Age at the Time of Death: 71 years
Method of Disposition: Burial
Place of Disposition: Auburn Cemetery Auburrm, Wyoming
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUED: Thursday, February 24, 2011
CG
This copy is not valid unless prepared on paper with an engraved. border.
Funeral Home or Facility:.
Facility: Schwab Mortuary, Afton, Wyoming
Cause of Death:
The immediate cause is listed on the first line followed by any underlying c .Uses.
(a)Alzheimers Disease
Other Significant
Conditions:
Manner of Death: Natural Death
Certifier:
Type: Physician
Name: Orson D.'Perkes, M.D.
Address: 110 Hospital Lane,; Afton, Wyoming, 83110
Date Filed: Februarp23, 2011
ounty of Death: Lincoln
Gladys K, Breeden
Deputy State Registrar