HomeMy WebLinkAbout962765I, Eileen Frazier, being of lawful age and duly sworn according to law, upon my
oath, depose and state:
That under the date of July 27, 1998, for valuable consideration, Benny E. Holt
and Dotty Holt (also known as Dottie Holt), by deed of that date, which deed was duly
filed of record in the Office of the Lincoln County Clerk, on September 16, 1998, in Book
417PR, Page 392, conveyed to Loren Frazier and Eileen Frazier, husband and wife, the
following described land, in the County of Lincoln, State of Wyoming, to -wit:
The Lot Numbered Ten (1o) of Block Numbered Ten (lo) of the Amended Plat of the
Town of Opal, County of Lincoln, State of Wyoming
That by reason of said conveyance aforesaid, the said Loren Frazier and Eileen
Frazier, husband and wife, became the owners of said real property, and the title thereto
vested in them continuously from the date of said conveyance, to the date of death of
Loren Frazier, on the 17th day of December, 2008. That by reason of and upon the death
of Loren Frazier, title in the above described real property vested in Eileen Frazier, as
sole owner.
Affiant avers and certifies that Loren Frazier, also known as Loren Delano
Frazier, is the identical party named with Eileen Frazier in the aforementioned deed,
whose death terminated his interest, title and estate in said real property; and Affiant
attaches hereto, and makes a part of this affidavit, a copy of the Official Certificate of
Death of said decedent, duly certified by the public authority in which said death
certificate is a matter of record.
Dated this j _ch day of 2011.
State of ()V t
ss.
County of
Subscribed and sworn to b$ore me, a notary public in and for said County and
State, by Eileen Frazier, this day of n (t 2011.
1 0111!11011/o 'o
WITNESS my hand and of�l.
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My Commission Expires:
This Document is being recorded by
Rocky Mountain Title Insurance Agency
of Lincoln County as a COURTESY only
Affidavit of Survivorship
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Eileen Frazier
Notary Public
00375
RECEIVED 1/17/2012 at 10:40 AM
RECEIVING 962765
BOOK: 779 PAGE: 375
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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ITAL RECORD'
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Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
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DECEDENT INFORMATION
Date Issued: January 8, 2009
AMENDMENT HISTORY
12/31 /2008 Birth State from Kansas to Missouri
12/31/2008 Spouse First Name from leleen to Eileen
12/31/2008 Informant First Name from leleen to Eileen
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Barry E. Nangle
State Registrar
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CERTIFICATI
December 17, 2008
Salt Lake City
64
Valley Park, Missouri
Yes
Eileen Tanner
Trucking Industry
Opal, Wyoming
Bessie Woolsey
University of Utah Hospital
1
CERTIFICATE OF DEATH
State File Number: 2008014121
Loren Delano Frazier
INFORMANT INFORMATION
Name: Eileen Frazier Relationship:
Mailing Address: 168 Wapiti Street, Opal, Wyoming 83124
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Houston Rural Cemetery, Mountain View, Missouri
Date of. Disposition: December 22, 2008
FUNERAL HOME INFORMATION
Funeral Home: Starks Funeral Parlor
Address: 3651 South 900 East, Salt Lake City, Utah 84106
Funeral Director: Shayneh L Starks
MEDICAL CERTIFICATION
Certifying Physician: John R Michael M D, 50 North Medical Drive, Salt Lake City, Utah 84132
CAUSE OF DEATH
Septic Shock [Onset: 2 Days]
Streptococcal Pneumoniae Septicemia [Onset: 2 Days]
Mantle Cell Lymphoma [Onset: 1 Year]
Tobacco Use: Unknown if User
Medical Examiner Contacted: No Autopsy Performed: No Manner of Death: Natural
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 of Vital Statistics.
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Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
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*062148866*
Wife
10:00
Salt Lake
February 11, 1944
Male
Married
Truck Driver
9th Through 12th Grade
Everett Frazier
Hospital Inpatient
UTAH DEPARTMENT OF HEALTH
Office of Vital Records Statistics
Salt Lake City, Utah
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