HomeMy WebLinkAbout960626RECEIVE 2011 at 10:34 AM
RECEMNG 960626
BOOK: 771 PAGE: 410
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
I, Dennis Wayne Birch, being of lawful age and duly sworn according to law, upon my
oath, depose and state:
That under the date of August 25, 2003, for valuable consideration, Lillian R. Birch, by
deed of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on
August 28, 2003, in Book 532PR, Page 693, conveyed to Lillian R. Birch, Dennis Wayne Birch and
Deanna Wallentine, as joint tenants with full rights of survivorship, the following described land,
in the County of Lincoln, State of Wyoming, to -wit:
All of Lot 14 of Block 1 of the Collett First Addition to the Town of Cokeville, Lincoln County,
Wyoming as described on the official plat thereof
That by reason of said conveyance aforesaid, the said Lillian R. Birch, Dennis Wayne
Birch and Deanna Wallentine, became the owners of said real property, and the title thereto
vested in them continuously from the date of said conveyance, to the date of death of Lillian R.
Birch, also known as Lillian Ruth Birch, on the 5th day of May, 2011. That by reason of and upon
the death of Lillian R. Birch, title in the above described real property vested in Dennis Wayne
Birch and Deanna Wallentine, as joint tenants with full rights of survivorship.
Affiant avers and certifies that Lillian R. Birch, also known as Lillian Ruth Birch, is the
identical party named with Dennis Wayne Birch and Deanna Wallentine in the aforementioned
deed, whose death terminated her interest, title and estate in said real property; and Affiant
attaches hereto, and makes a part of this affidavit, a copy of the Official Certificate of Death of
said decedent, duly certified by the public authority in which said death certificate is a matter of
record.
lk
Dated this day of�i 2011.
State of kI Yr\)
c ss
County of >w�.e-IZ1;aC4I
Affidavit of Survivorship
Subscribed and sworito before me, a not public in and for said County and State, by
Dennis Wayne Birch, this day ofJ 2011.
WITNESS my hand and official seal.
My Commission Expires: `l'" \?rfit~-
This Document is being recorded by
Rocky Mountain Title Insurance Agency
of Lincoln County as a COURTESY only
4%
000410
nis Wayne Birch
Notary
r JILL A. CHAFFIN NOTARY PUBLIC
o
r State of
County of ai;t j Wyoming
Sweetwater
My Commission Expue Match 10, 2011122
1
Date Filed
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU•OF•VITAL RECORDS AND HEALTH STATISTICS
DECEDENT LEGAL NAME
LILLIAN RUTH? B :IRCH
SEX
FEMALE
S. SOCIAL SECURITY NUMBER
BIRTHPLACE
COKEVILLE, WYOMING
MARITAL STATUS AT TIME OF DEATH
WIDOWED
FATHER NAME
ROBERT HAMILTON BRUCE
MOTHER MAIDEN: 'MME
CLARA LOU.ISE`NICHOLLS
METHOD OF DISPOSITION
REMOVAL FROM STATE
3
PLACE .OF'RESIDENCE
COKEVILLE, WYOMING
:.NAME:OF SURVIVING SPOUSE (If vele, maiden name)
BIRTHPLACE
WYOMING
la' RR-PLACE
MONTANA
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
NO
DATE OF DEATH TIME OF DEATH CITYrTOVJN:.OR LOCATION OF DEATH COUNTY OF DEATH
MAY 05, 2011 9:42 A.M. MONTPELIER, IDAHO BEAR LAKE
CAUSE OF DEATH (underlying cause last) Approximate Interval Between
Onset and Death
PNEUMONIA DAYS
DUE TO (or as a consequence of):
DUE TO (or as a consequence of):
DUE TO (or as a consequence of)
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting in theunderlying cause given above WAS
PERFORMED?
AUTOPSY
PERFORMED?
OSTEOARTHRITIS, HYPERTENSION< NO
MANNER OF DEATH NAME OF CERTIFIER' TITLE
NATURAL JACK 0. CLARK, M.D. PHYSICIAN
CORONER SUBSE IF NECESSARY
DATE OF INJURY
DESCRIPTION OF HOW INJURY OCCURRED
TIMEOF INJURY
LOCATION WHERE INJURY OCCURRED
This is a true :and correct .reproduction of the dobument officiallyy reggistered and placed
on file with the IDAHO BUREAUOF VITAL:RE.CORDS AND:HEALTH STATISTICS.`
JUNE: 07.:, 2011
DATE ISSUED-
This copy not valid unless.` prepared on engraved border
displaying state seal and;signature.of the Registrar.:
PBNCO (Rev) 07/10
JAMES B AYDEL.OTTE
STATE REGISTRAR
201.1 -04858
T a
PLACE OF INJURY I W uY AT
WORK?
111..71 nil IIMUClIl1I1i\
Is CERTIFICATION OF VITAL RECORD