HomeMy WebLinkAbout962443AFFIDAVIT OF SURVIVORSHIP
I, LYDIA CORSI, being duly sworn under oath, state as follows:
1. That I, Lydia Corsi, the surviving spouse of Jack O. Corsi, Sr., hereby certify that
Jack O. Corsi, Sr. died on November 8, 2011. Attached hereto is an original copy of the
Certificate of Death issued for Jack O. Corsi, Sr.
2. That Jack O. Corsi, Sr. had tenancy by the entireties with me in land in Lincoln
County, Wyoming, more particularly described as follows:
See the attached Quit Claim Deed creating the tenancy by the entireties that was
recorded in the Lincoln County, Wyoming, land records in Book 577 at Page 816 on
January 27, 2005 as Receiving No. 906107.
3. That pursuant to Wyoming Statutes 2 -9 -102, I certify that the tenancy of Jack 0.
Corsi, Sr. has been terminated by his death, and that title to the above referenced land is now in
the name of Lydia Corsi, a single woman.
DATED this 2O h of December, 2011.
STATE OF WYOMING
SS.
COUNTY OF LINCOLN
SUBSCRIBED AND SWORN TO before me by LYDIA CORSI this ZA day of
December, 2011.
WITNESS my hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of State of
Lincoln Wyoming
My Commission Expires: July 16, 2015
My Commission expires: 01
l
6
c CO RS C d
NOTA Y PUBLI
00224
RECEIVED 12/22/2011 at 10 :48 AM
RECEIVING 962443
BOOK: 778 PAGE: 224
JEANNE WAGNER
LINCOLN COUNTY CLERK KFRARAPpoo
31423(02)
WHEN RECORDED RETURN TO:
Name:
Address:
Jack 0. Corsi Sr.
P 0 Box 3673
Alpine, WY 83128
JACK 0. CORSI, SR., a married man, GRANTOR(S) of Lincoln County, State of Wyoming, hereby
QUIT CLAIMS to JACK 0. CORSI, SR. and LYDIA CORSI, husband and wife, as tenants by the
entireties, GRANTEE(S), whose address is P 0 Box 3673, Alpine, WY 83128 for the sum of One
Dollar and other good and valuable consideration, the following described real estate, situate in Lincoln
County, State of Wyoming, to -wit:
Lot 22 of Corsi Ranchettes, Second Filing as shown by the official plat thereof, recorded November 2,
1995 as Instrument No. 810869 in the Office of Clerk of Lincoln County, Wyoming.
also known by street and number as: 106 Alpine Hills Drive, Etna, WY 83118
Subject to reservations and restrictions contained in the United States Patent and to easements and
rights -of -way of record or in use.
Together with all improvements and appurtenances thereon.
WITNESS, the hand of said grantor this 13th day of January, 2005.
k 0. Corsi, Sr.
STATE OF WYOMING
COUNTY OF TETON
The foregoing instrument was acknowledged before me this 13th day of January, 2005, by
Jack 0. Corsi, Sr. the signer of the within instrument, who duly acknowledged to me that he
executed the same.
WITNESS MY HAND AND OFFICIAL SEAL.
Aitact) A-
Notary Public: Gloria K. Byers
My commission expires September 15, 2007.
GLORIA K. HERS NOTARY PUBLIC
County of State of
Lincoln tt Wyoming
My Commission Expires Sept. 15, 2007
Land Title Company File Number: 31423
Quit Claim Decd (individual) Page 1 or 1
RECEIVED 1/27/2005 at 10:36 AM
RECEIVING 906107
BOOK: 577 PAGE: 816
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
QUIT CLAIM DEED
(Individual Form)
itittam
Decedent:
:Name:
Gender:
Date of Birth:
Additional Decedent
Place of Birth:
Residence:
Marital Status:
Armed Forces:
:Name of Fther:
Name of Mother:
Informant:
Disi osition:
Method of Disposition:
Place of Disposition:
Other.. Significant
Conditions:
Manner of Death:
Certifier:
T
Name:
Address:
Date Filed:
Date and Place of Death:
Date of Death:
City of Death:
:Location:
VITAL RECORD s
Information:
Afton, Wyoming
Etna, Wyoming
Married Lydia Steglich
Yes
George Elmo Corsi
Annie Ames
Lydia Corsi
r
Natural Death
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
November 08, 2011
Afton
Star Valley Medical Center 110 Hospital Lane
Cremation
Schwab Mortuary Crematory, Afton, Wyoming
Relationship:
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 causes.
(a) Listeria Monocytogenes, Invasive.
(b) Corona y artery disease
(c) Atrial fibrillation
Time of Death:
State File Number:
Jack Oliver. Corsi
Male Social. Security Number:
November 16, 1923 Age at the Time of Death:
County of Death:
Physician
Christian M. Morgan, M.D.
110 Hospital Lane, PO Box 579, Afton, Wyoming, 83110
November 16, 2011
2011 003463
87 years
Lincoln
Interval:
weeks
years
years
AtnerL,a
Thomas O. Forslund
Director and State Registrar
This copy is not valid unless prepared on paper with an engraved border.
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