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STATE OF WYOMING
COUNTY OF LINCOLN
AFFIDAVIT OF SURVIVORSHIP
SS.
I, Arlene Kirkwood being of lawful age and duly sworn according to law upon my oath
and depose and state:
1. That I am of adult age, a resident of Diamondville, Wyoming and the Affiant herein.
2. That by virtue of the conveyance which is recorded in the Office of the Clerk for Lincoln
County, Wyoming, located at Kemmerer, Wyoming in Book 108PR on page 491 is recorded a
Warranty Deed dated April 23, 1973, which conveys unto Arthur Kirkwood or Arlene Kirkwood,
husband and wife by the entireties, the following property more particularly described, to -wit:
Parcel 112 of the Town of Diamondville, Lincoln County, Wyoming. Said property now
known as Lot 9 of Block 2 of the Follies of 42 Addition to the Town of Diamondville,
Lincoln County, Wyoming as described on the official plat filed with Instrument No.
659876.
3. That said Arthur Kirkwood aka Art Kirkwood died on the 30th day of August, 2011, and
a copy of the original certificate of death, certified to be true and correct by public authority in
which the original of said certificate is a matter of record, is attached hereto as Exhibit "A
4. That by reason of death of said Arthur Kirkwood and by reason of state statutes, the
decedents interest and title in said property has terminated and title to the real property conveyed
thereby has vested absolutely in Arlene Kirkwood con."iinuously since the death of the said
decedent.
FURTHER AFFIANT SAYETH NOT.
Arlene Kirkwoo
The foregoing instrument was subscribed and sworn to before me by Arlene Kirkwood
this l -day of :/%cam 2011.
Witnessed my hand and official seal.
Commission Expires:
RECEIVED 3/1/2012 at 12:46 PM
RECEIVING 963450
BOOK: 782 PAGE: 145
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Notary Public
00115
O
get. 14,1*
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Other Significant.
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
.07
CHF
Arthur Kirkwood
Male
June 25, 1926
1
STATE OF WYOMING
August 30, 2011
Kemmerer
South Lincoln Medical Center •PO Box
Information:
Diamnndville, Wyoming
Diamondville, Wyoming
Married Arlene M. Stefonick
Yes
George Kirkwood
Rachael Armstrong
Arlene M. Kirkwood
549491
4
■s),r
This copy is not valid unless prepared on paper with an engraved border..
This is a true certification of the document on file iii the office of Vital
Statistics Services, Cheyenne, Wyoming.
-5 aWAW.&*cia:.'
DATE ISSUED: Thursday, September 15, 2011
VrfAL RECORD
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Social Security Number:
Age at the Time of Death:
County of Death:
390
Disposition:
Method of Disposition:
Place of Disposition:
.Funeral HOme or Facility:
Facility: Ball Family Chapel, Evanston, Wyoming
Cause of Death!
The immediate cause is /iSted on the first line followed by any underlying causes.
(a) Probable CAD
(b) COPD
Cremation
Utah Cremation Center, West Jordan, Utah
Physician
George C. Krell, M.D.
PO Box 390, Kemrnerer, Wyoming, 83101
September 14, 2011
ti *VW trr
4
Relationship:
Natural Death Time of Death:
Wife
00:31 (Actual)
Matthew T, Rowe
c. 0 e ti 'Interim Deputy State Registrar
te
Olady. IC.
Deptft-Sterte-Regisirerr
2011-002709
85 years
Lincoln
Interval:
Minutes
Years
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0 1 4 6
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CERTIFICATI
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