HomeMy WebLinkAbout964289The State of Wyoming}
County of Lincoln
SS.
RECEIVED at 11:04 AM
RECEIVING 964289
BOOK: 785 PAGE: 256
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
I, Evelyn Karen Buck, being of lawful age and first duly sworn according to law,
upon my oath, depose and state:
1. That Alice Antilla, entered into a Warranty Deed with the above
named, as joint tenants and not as tenants in common with full
right of survivorship in the real property at 417 Pine Avenue,
Kemmerer, Wyoming on the 22 of April 1996.
2. That which deed was duly filed for record in the office of the Lincoln
County Clerk to wit:
All of the lot numbered eight (8) in block numbered thirty -one
(31), in the first addition to the Town of Kemmerer, Lincoln County,
Wyoming as surveyed, platted and recorded, together with all
improvements thereon.
3. That Alice Antilla died on 22 of December, 2007 at the South
Lincoln Medical Center in Kemmerer, Wyoming, County of Lincoln;
that the death of Alice Antilla terminated the estate by the
entireties and affiant Evelyn Karen Buck became owner of the above
property.
4. Affiant avers and certifies that deceased is the identical party
named with Affiant in the aforementioned deed whose death
terminated her interest, title and estate in the real property; and
Affiant attaches hereto and makes a part of this Affidavit, a copy of
the official certificate of death of decedent, duly certified by the
public authority in which said death certificate is a matter of record.
DATED: April
Evelyn Karen Buck
2012
AFFIDIVIAT
00256
STATE OF WYOMING}
ss.
COUNTY OF LINCOLN}
acknowledged before me the
2012, by Evelyn Karen Buck.
official seal.
The foregoing instrument was
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LAME PAINTER NOTARY Pi ci}C
COUNTY OF
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STATE OF
WYOMING
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00257
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Decedent:
Name:
Gender:
Date of Birth;
Alice Antilla
Female
March03, 1915
Date and Place of Death:
Date of Death December 22, 2007
City of Death: Kemmerer
Additional Decedent Information:
Place of Birth:' E3ennirigton, Idaho::
ResiderlOe: Kemmerer, Wyoming
Marital Status: Widowed
Name of Father P.ercuval Buck
Maiden Name of Mother: Alice Bacon
Informant: Karen Buck
Disposition:
Method of Disposition: Burial
Place of Disposition:
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes. Interval:
(a) Possible Coronary Artery Disease <1 Day
Other Significant Conditions: Not Recorded
Manner of Death: Natural Death Time of Death: 17:44
Certifier:
Name: Chris Krell, M.D.
Address: 711 Onyx, Kemmerer, Wyoming
Date Filed: December 27, 2007
363072
STATE OF WYOMING
4 4,
a.-Kitit
DEPARTMENT OF HEALTH
Kemmerer Cemetery, Kemmerer, Wyoming
This is a true certification of the document on file in the office of Vital
Records Services, Cheyenne, Wyoming,
DATE ISSUED• January 04, 21)08
DEATH CERTIFICATE
This copy is not valid rtificss/preparcd onpaper with sn eigtavc0 horde".
44404
ANY ALTE AT 0
State File Number: 2007-003799
Social Security Number:
Age at the Time of Death 92 years
COUnty bf Death: Lincoln
Relationship: Daughter
Gladys K. Breeden
Deputy State Registrar
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