HomeMy WebLinkAbout964315State of Wyoming
County of Lincoln
I Patricia E. Kozas (aka Mrs. William S. Kozas, Patricia Dexter), residing at 2409 Morrie
Avenue, Cheyenne, Wyoming 82001, being of legal age, depose and say that:
1. On October 22, 1985, by Quit Claim Deed recorded in Book/Volume 782, Page 606, of the
Lincoln County records as document number 00606 963577 ('the Deed'), the Affiant and
William S. Kozas become owners of the following legally described property:
Lot 15 of Block 7 of the Original Town of LaBarge, formerly Tulsa, Lincoln County,
Wyoming.
2. Affiant and William S. Kozas own the property in joint tenancy with right of survivorship.
3. On December 05, 2002, William S. Kozas, died, thereby terminating William S. Kozass
interest in the above described real property. A certified copy of the death certificate of William
S. Kozas is attached hereto as Exhibit A.
Oath or Affirmation
I certify under penalty of perjury under Wyoming law that I know the contents of this affidavit
signed by me and that the statements are true and correct.
RECEIVED 4/27/2012 at 4:08 PM
RECEIVING 964315
BOOK: 785 PAGE: 333
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Affidavit of Survivorship
Patricia E. Kozas (aka Mrs. William S. Kozas, Patricia Dexter) Date
STATE OF WYOMING, COUNTY OF LINCOLN, ss:
This Affidavit was acknowledged before me on this 0, day of aptia
0 C by Patricia E. Kozas (aka Mrs. William S. Kozas, Patricia Dexter), who, being first duly
sworn on oath according to law, deposes and says that he /she has read the foregoing Affidavit
subscribed by him/her, and that the matters stated herein are true to the best of his/her
information, knowledge and belief.
1 �l -C %1 LuQ
Notary Public
Title (and Rank)
i
My commission expires U
COUNTY OF
ARAM ■E
BRONWYN PFLUGHOEFT NOTARY PUBLIC
4
STATE OF
WYOMING
MY COMMISSION EXPIRES MAR. 18, 2013
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ji CERTIFICATION OF VITAL RECORD
STATE OF WYOMING
SPIEROS
toe MAILING MOMS STREET DR RFA MUTES
2409 Morrie•Avenue,
DEPARTMENT OF HEALTH
STATE OF WYOMING.
DEPARTMENT OF HEAL TTH
CERTIFICATE OF DEATH'
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This is a true certification of the document on file in the office of Vital
Statistics Services,. Cheyenne, Wyoming:
DATE ISSUED: MAR -6 20 I`.
This copy is not valid unless prepared on paper with an engraved border.
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SOnM RE MASER
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KOZAS Male December.5, 2002
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Patricia Dexter
n.MK9 0E43E0524T EVER M II$ 5165o FORCES? '41L 8611.00CUIRID( Me NW 0(' 602 We ebnSNOwt 12.XRO OF eIMME680R 61AIS1RY
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Yea Watercraft Supervisor {;State of Wyoming
li. SESsloteE •sDDE. 131. COOT 13e CO/Y. PORN OR 1.02.5 0311 13A. 5TREEr MO MATER
Wyoming Laramie Cheyenne ..l 2409 Morrie Avenue
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Cub" Maim% Pula RxwREel (21r15y)
No 1p" MN 0 (Al.ray) White
August 27, 1926
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CJTY OR TOWN SERE
Cheyenne,. Wyoming
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Director and State Registrar
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