HomeMy WebLinkAbout961014STATE OF WYOMING
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COUNTY OF LINCOLN
GEORGETTE A. HARMAN, being first duly sworn on oath deposes and say:
1. That Georgette A. Harman is of adult age and is the surviving wife of Bond Sidney
Harman, who died November 6, 2009, in Salt Lake City, Utah, as hereinafter more fully appears.
2. That by a Quitclaim Deed dated May 18, 2001, and recorded May 21, 2001, in the
office of the Lincoln County Clerk in and for the County of Lincoln, State of Wyoming, in Book
464 PR, Page 914, Bond S. Harman and Georgette Amussen, n /k/a Georgette Harman, as joint
tenants, conveyed to Bond S. Harman and Georgette Harman, husband and wife, as tenants by
the entireties, of P.O. Box 819, Thayne, Wyoming 83127, Lincoln County, State of Wyoming, the
following described real estate situated in Lincoln County, State of Wyoming, to -wit:
A parcel of land located in the NE /4NE' /4 of Section 13, T34N R1 19W of the 6
P.M., Lincoln County, Wyoming, and being a portion of that tract in Book 173PR
on page 147, in the Lincoln County Clerk's Office, and being more particularly
described as follows:
BEGINNING at a spike in the country road, South 397.84 feet from the Northeast
corner of said Section 13, where is found a spike in the county road witnessed 30.00
feet East and West by BLM type brass caps set by RLS 578;
thence South, 402.33 feet along the East line of said Section 13 to a spike in said
county road;
thence N 89 °32'00" W, 306.25 feet to a point;
thence North 397.44 feet to a point;
thence N 89 °33'06" E, 306.25 feet along a post and pole fence to the POINT OF
BEGINNING.
TOGETHER WITH all improvements and appurtenances thereon.
3. That Bond Sidney Harman died on the 6 day of November, 2009, in Salt Lake
County, State of Utah, and thereupon, the certificate of his death was duly filed with
the State of Utah 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 Bond Sidney Harman, as aforesaid, the joint tenancy created
by the aforesaid deeds were terminated, and Georgette A. Harman, surviving wife, became vested
wit 11 of his ri t, title an estate in the above property.
I r g
G,rgL tte A. 3 I an
SUBSCRIBED AND SWORN to before me by Georgette A. Harman this A5 day of
B NOTARY PUBLIC
County o State of
Lincoln;:a Wyoming
AFFIDAVIT OF SURVIVORSHIP
My r:nmrr.icc rv: l= ern "sr 4?r, Ai in t .ii 9(116.
ay of September, 2011.
Notary Publi
000885
RECEIVED 9/16/2011 at 10:48 AM
RECEIVING 961014
BOOK: 772 PAGE: 885
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
CERTIFICATION OF VITAL RECORD
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DECEDENT INFORMATION
Dete of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
November 6, 2009
Salt Lake City'
65
Salt Lake City, Utah.
No
Georgette Amussen
Golf
Thayne, Wyoming
June Bond
University of Utah Hospital
E OF UTAH
CERTIFICATE OF DEATH
State File Number: 2009025108
Bond Sidney Harman
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Fathers Name:
Facility Type:
INFORMANT INFORMATION
Name: Georgette A Harman Relationship: Wife.;
Mailing Address: P.O. Box 819, Thayne, Wyoming 83127
DISPOSITION INFORMATION
Method of Disposition: Cremation /Removal
Place of Disposition: Larkin Sunset Lawn Crematory, Salt Lake City, Utah
Date of Disposition: November 12, 2009
FUNERAL HOME INFORMATION
Funeral Home: Larkin Sunset Lawn;
Address: 2350 East 1300 South, Salt Lake City, Utah 84108
Funeral Director: Dale. J Hickman
MEDICAL C6ITIFICATION
Medical Professional: David Bull MD, 50 North Medical Drive, Salt Lake City, Utah 84132
CAUSE OF DEATH
Adult Respiratory Distress Syndrome [Onset: 12 Hours]
Pneumonia [Onset: 3 Weeks]
Lung Cancer [Onset: 3 Months]
Tobacco Use: Unknown
Medical Examiner Contacted: Yes Autopsy Performed: No Manner of Death: Natural
Date Issued: November'12, -2009
18:08
Salt Lake.
March 29, 1944
Male
Married
Golf Course Superintendent
Some College but No Degree
Alonzo Harman
Hospital Inpatient
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This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V R images in top cycloids,
ultra violet fibers and hologram image of the Utah State Seal, over the words "State of Utah This
document displays the date, seal and signature of the State Registrar and the County /District Health Officer.
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Barry E. Nangle, State Registrar
Office of Vital Statistics
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*06.2509622*
Garyk. Edwards
Director /Health Officer
County /District Health Department
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