HomeMy WebLinkAbout962630AFTER RECORDING RETURN TO:
Kelly S. Davis
Attorney at Law
408 West 23r Street, Suite 1
Cheyenne, Wyoming 82001
AFFIDAVIT OF SURVIVORSHIP SHOWING
TERMINATION OF ESTATE BY THE ENTIRETIES
I, JOAN M. REED, having been first duly sworn upon my oath as provided by
law, depose and state as follows:
RECEIVED 1/9/2012 at 10:39 AM
RECEIVING 962630
BOOK: 779 PAGE: 96
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
1. That I am the surviving spouse of ROBERT I. REED, who died on
November 25, 2011, in Pocatello, Bannock County, Idaho, a resident thereof.
2. That attached hereto and made a part hereof by this reference is a
certified copy of the Certificate of Death of said ROBERT I. REED, on file and of
record in the office of the Idaho Department of Health and Welfare, Bureau of Vital
Records and Health Statitstics.
3. That this Affiant and said decedent were husband and wife and the
Grantees under that certain Warranty Deed, executed on April 25, 2001, by R.
BYRON BAKER, Grantor, and recorded on May 1, 2001, in Book 463 at Page 530,
of the real estate records in the official records of the Clerk of Lincoln County,
Wyoming, and concerning the real property situated in the County of Lincoln, State
of Wyoming, whereby the following described real property was conveyed to them:
Lot 608 -C, Lakeview Estates Subdivision, Lincoln County,
Wyoming, as said lot is laid down and described on the
official plat of said addition duly recorded in the Office of
the County Clerk and Ex- Officio Register of Deeds of
Lincoln County, Wyoming, and that portion of Lot 651 -C in
said Lakeview Estates Subdivision and described as
follows: BEGINNING at a point on the Northerly boundary
line of said Lot 651 -C and the Southerly right -of -way line
of U.S. Highway 89 from which point of beginning the
Northeasterly corner of said Lot 651 -C lies N63 °11'E, a
distance of 100 feet; THENCE from said point of
beginning, S26 °49'E, a distance of 70 feet, more or Tess,
to the Northeasterly corner of Lot 608 -C of said Lakeview
Estates Subdivision; THENCE along the Northerly
boundary line of Lot 608 -C of said Lakeview Estates
Subdivision a distance of 100 feet, more or Tess, to the
Northwesterly corner of said Lot 608 -C; THENCE
N26 °49'W, a distance of 70 feet, more or less, to a point
on the Southerly right -of -way line of U.S. Highway 89;
THENCE N63° 11'E, along said Southerly right -of -way line
a distance of 100 feet, more or less, to the point of
00096
beginning.
4. That this Affiant and said decedent, as husband and wife, held their joint
interest in and to the above described property as tenants by the entireties, a
survivorship interest which terminated by ROBERT I. REED's death on November
25, 2011.
5. That this Affidavit is made as authorized by W. S. 2 -9 -102, for the
purpose of establishing the termination of said estate by the entireties and for the
purpose of showing that this Affiant, JOAN M. REED, as the surviving spouse, has
been the sole owner of the above described real properties since the death of her
husband, ROBERT I. REED.
Further Affiant sayeth not.
Dated this 4 day of 'toe he/r 20 (f
STATE OF
ss.
COUNTY OF Ski'
Witness my hand and official seal.
N M. REED AFFIANT
SUBSCRIBED AND SWORN TO by the Affiant, JOAN M. REED, before
me this 1$ day of 0 u°-4 Z.4. 20
NOTARY PUBLIC
My Commission Expires: /z-1'v1i3
00097
SIX
MALE
SOCIAL SECURITY NUMBER
AGE
72 YEARS
DATE OF BIRTH
MARCH 16, 1939
BIRTHPLACE
IDAHO FALLS, IDAHO
PLACE OF RESIDENCE
POCATELLO, IDAHO
MARITAL STATUS AT TIME OF DEATH
MARRIED
NAME OF SUR/WING SPOUSE (If wife, maiden name)
JOAN M. MERRELL
WAS DECEDENtEVER IN
U.S. ARMED FORCES?
NO
FATHER NAME
RONALD I. REED
BIRTHPLACE
NEBRASK
MOTHER MAIDEN NAME
HILMA C. LARSON
BIRTHPLACE
NORTH DAKOTA
METHOD OF DISPOSITION
CREMATION
FUNERAL SERVICE LICENSEE
SCOTT M. CORNELISON
NAME AND ADDRESS OF FUNERAL FACILITY
CORNELISON- H.ENDERSON FUNERAL HOME, POCATELLO, IDAHO
DATE OF DEATH
NOV. 25, 2011
TIME OF DEATH
2:10 P.M.
CITY,TOWN OR LOCATION OF DEATH
POCATELLO, IDAHO
COUNTY OF DEATH
BANNOCK
CAUSE OF DEATH (underlying cause last) Approximate:lnterval Between
a SQUAMOUS CELL CA RECTUM o MONTHS
MONTHS
DUE TO or as a consequence of):
b 'DEMENTIA YEARS
DUE TO (or as a consequence of):
DUE TO (or as a consequence of):
d.
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting in the underlyin cause given above
NONE STATED
WAS ANAUTOPSY
PERFORMED?
NO
MANNER OF DEATH
NATURAL
NAME OF CERTIFIER
TONY C. ROISUM, M.D.
TITLE
PHYSICIAN
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
te r
sr.,
DATE OF INJURY
m���
TIME OF IWURY
PLACE OF INJURY
I U' A
WORK?:`
LOCATION WHERE INJURY OCCURRED
This is a true and correct reproduction of the document officially registered and placed
.SEA 4 1 r1j on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS.
0,
re's
0 f DATE ISSUED:
s This copy not valid unless prepared on engraved border
displaying state seal and signature of the Registrar.
PBNCO (x.h 07/10
DECEMBER 01, 2011
ITAL RECORD
LP.
JAMES B. AYDELOTTE
STATE REGISTRAR
i' 1 9 '�fln d
it L 1 tiir' e
Date Filed
DECEDENT LEGAL NAME
ROBERT I. REED
DECEMBER 01, 2011
WI MIII DILIJCIAIILI1(IMP
STATE OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
CERTIFICATE OF DEATH
V 0V 8
State File No.
20 10640
0
d..