HomeMy WebLinkAbout960778STATE OF WYOMING
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COUNTY OF LINCOLN
AFFIDAVIT OF SURVIVORSHIP
Ow) 66
Eugene A. Root of PO Box 191, Thayne, WY 83110, upon his oath deposes and says:
1. That VERA BELLE ROOT aka Vera B. Root, the decedent mentioned in the
attached copy of State of Wyoming Certificate of Death, is the same person as VERA B. ROOT
named as one of the grantees in that certain Warranty Deed dated the 29th day of December,
2003, executed by Holy Family Church, grantor, and recorded January 7, 2004, in Book 545 PR,
page 721, of the Official Records of Lincoln County, Wyoming, covering the following described
real property located in Lincoln County, Wyoming, to -wit:
Lot 18 of Star Valley Ranch Plat 5, Lincoln County, Wyoming, as described on the
official plat thereof.
2. That the undersigned affiant is the same identical person as Eugene A. Root named
as one of the grantees in the above described Warranty Deed, that VERA BELLE ROOT and he
were husband and wife at the time of the execution and recording of the Warranty Deed described
above, and that as the surviving cotenant and spouse of VERA BELLE ROOT, named in said
conveyance, the undersigned, Eugene A. Root, became on April 30, 2011, the date of the death of
the aforementioned decedent, the owner of the lands or the owner of any interest of VERA BELLE
ROOT, in the lands described in the foregoing, subject to any then existing liens and
encumbrances.
DATED as of the 26th day of August, 2011.
RECEIVED 8/31/2011 at 11:20 AM
RECEIVING 960778
BOOK: 771 PAGE: 866
JEANNE WAGNER
1 inirni Al rni IMTV •i PP"( L PRAMFpFp IAN
1
Eugene A. Root
Subscribed and sworn to by Eugene A. Root before me thisc q day of August, 2011.
Witness my hand and official seal.
GERALD L. GOULDING NOTARY PUBLIC
County of
(.r� State of
Lincoln
Wyoming
My Commission Expires May 2, 2015
My commission expires: May 2, 2015.
2
off°
NOTARY PUBLIC
0)08'7
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent Inform
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition: Schwab Mortu C ry Afton, Wyoming
Funeral Home or Facility
Facility:
Cause! of. Death
The immediate cause is listed on the first line followed. by any underlying causes.
(a) Alzheimers Dementia
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
Vera Belle Root
Female
October 29, 1933
April 30, 2011
Thayne
1952 MuddyString Rd.
atlon:
Thayne, Wyoming
Thayne,'Wyommg
Married' Eugene Albert Root
Pearlie -Cox
Mattie Cleo McDonald
Eugene Albert"Root
Cremation'
Mortuary r rna t o
Natural Death
526179
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUED: Monday, May 09, 201
This copy is not valid unless prepared on paper with an engraved border
CERTIFICATE .OF DEATH
DEPARTMENT OF HEALTH
CERTIFICATI s ITAL RECORD
State File Number:
Soeial.Security Number
Age at the Time of Death:
Physician
Christian M. Morgan, M.D.
110 Hospital Lane, PO Box 579., Afton, Wyoming, $3110
May 07, 2011
Gladys K. Breeden
Deputy State Registrar