HomeMy WebLinkAbout961856State of WY
ss.
County of Lincoln
Evelyn B Fay, being first duly sworn upon His /Her oath, deposes and states as follows:
1.On the co- a 1 I e000 my husband, Colin M Fay passed away, as is
evidenced by the official certificate of death attached hereto and incorporated herein by
this reference.
2. At the time of death my wife /husband jointly owned certain real property with
me, said real property being located in the County of Lincoln, State of Wyoming, and
more particularly described as follows:
PARCEL 1
ALL OF LOT 20 OF THE STAR VALLEY RANCH PLAT 6, LOCATED IN LINCOLN COUNTY, WYOMING,
FILED JUNE 30, 1971 AS INSTRUMENT #431710 IN THE OFFICE OF THE LINCOLN COUNTY CLERK.
PARCEL 2
PART OF LOT 117 OF THE STAR VALLEY RANCH PLAT 7, LOCATED IN LINCOLN COUNTY,
WYOMING, FILED AUGUST 4, 1971 AS INSTRUMENT #432466 IN THE OFFICE OF THE LINCOLN
COUNTY CLERK, SAID PART BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE EASTERLY CORNER COMMON TO SAID LOT 117 AND LOT 20, PLAT 6
OF STAR VALLEY RANCH AND RUNNING THENCE N 67 °40'W ALONG THE LINE COMMON TO SAID
LOTS, 41.38 FEET; THENCE N 59 °16'07" E, 13.44 FEET; THENCE S 49 °47'22" E, 35.00 FEET TO THE
POINT OF BEGINNING.
3. Said real property was originally conveyed to Colin M Fay and Evelyn B Fay,
husband and wife, as tenants by the entireties by Court Officers Deed, dated
October 101994, and recorded in the office of the Lincoln County Clerk and Ex- Officio
Register of Deeds on October 24, 1994, in Book 359PR at Page 336.
4. By reason of Colin M Fay's death, I am entitled to sole ownership of the
above mentioned real property.
Dated this I JDvenlhe)( q,aDt
Evelyn y
Subscribed and Sworn to and acknowledged before me this kmvy1 be( 9, aDk by
Evelyn B Fay.
Witness my hand and official seal.
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Affidavit of Survivorship
Notary Public
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RECEIVED 11/10/2011 at 4:12 PM
RECEIVING 961856
BOOK: 776 PAGE: 78
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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FULL ...NAME. OF DECEASED
DATE CiF DEATH
DATE OF BIRTH
MOTHER'S NAME
FATHER'S NAME
PLACE OF DEATH
MARITAL STATUS
SpU
SOCIAL SECURITY NUMBER
RESIDENCE
PLACE. 0 ofspbs 'TON
COLIN MACFIE FAY
OCTOBER 21, 2000
JULY 17, 1930
MARGARET HARMON
WALLACE M FAY
UNITY, NEW HAMPSHIRE
MARRIED
EVELYN BROWN
008-18-5882
THAYNE, WYOMING
CLAREMONT CREMATORIUM
CERTIFIED ABSTRACT OF A CERTIFICATE Or DEATH
.cLAwgmONZ, NEW HAMPSHIRE TINAL PLACE OF DISPOSITIO HILL -CEMETERY, SHELBURNE, ZSSACUUSETTS
DATE OF DISPOSITION OCTOBER 24, 2000
MANNER OF DEATH :NATURAL:
CAOSE:OFDEATH
a PNEUMONIA HYPOSTATIC BIBASILAR
b DEMENTIA (SEVERE); MULTI-INFARCT
OTHER SIGNIFICANT CONDITIONS
CORONARY ARTERY DISEASE
DESCRIBE HOW INJURY OCCURRED
6ATE/IIMEOT INJURY
•FLAcET)F INJURY
LOCATION OF INJURY
NAME,AND,ADDRESs OF CERTIFLER.
(ATHEROSCLEROTIC)
HYPERTENSION
SEX MALE
AGE 70 YRS
BIRTHPLACE PROCTOR, VERMONT
FILE DATE OCTOBER 24 2000
sTEPHENR MOORE 4ss0cIATks IN Mb LAMQT, NEW HAN$HIRE 0
MARGINAL NOTES
900010
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DATE ISSUED: April 14 200.5 STATE CITY/ O
TWN OF:
This co not v unless prepared on engraved border displaying seal and signature of Registrar.
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f ir=" 1 It shall be unlawfui for anyone to reproduce this certificate other than local or State Registrar.
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I HEREBY CERTIFY THAT THIS IS A TRUE ABSTRACT ISSUED FROM THE OFFICIAL RECORDS ON FILE AT THIS
OFFICE.
WWin R. Bolt.?‘■ Jr.
St R'66'L'tr'r
QTAREMONT
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