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HomeMy WebLinkAbout964913RECEI /2012 at 2:41 PM RECEIVING 964913 BOOK: 787 PAGE: 283 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY File No.: 144938 STATE OF(p,ya.5 SS. COUNTY OFt fa f 5 Chi 7. Cr aic W'tness my hand and official seal. Alliance Title Escrovt PO Box 1367 Kemmerer WY 83101 2012 AFFIDAVIT TERMINATING ESTATE 1, C',¢/L✓f D,CR being of lawful age and first duly sworn according to law, upon my oath, depose and state: 1. That I am of adult age, a resident of t S 1 abt./ X AS and the Affiant herein. 2. That by virtue of the conveyances which are recorded in the office of the County Clerk for Lincoln County, Wyoming, located at Kemmerer, Wyoming is recorded a Warranty Deed dated the g day ofs`e 7'114/ 1q4© in Book ,2 9 0 PR on page /0 3 conveys unto 6"4 49 0-6,70 Rau,) C,' /6- the following described property, to -wit: 3. That said 6RRU.. y it1 S. Ct /c/on the day of,.A k .00 died and a copy of the original certificate of death, certified to as 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 ClfAdg d) ST C C by reason of 2 -9 -102 W.S. (1980), the decedents interest and title in said conveyance has terminated and title to the real property conveyed thereby has vested absolutely in G 1) (2 y p, c continuously since since the death of the said decedent. FURTHER AFFIANT SAYETH NOT. `3 ,2012 Gar D. 7 I 4Y 7 State ofT'xds )ss. County o The foregoing instrument was subscriband sworn to me by this 3 E day of Notary Public My Commission Expires:1 J(y� ZfJ t L,I 1 ,lkYFU KRISTIN ASHLEY GOBLE B Notary Public, State of Texas Commission Expires My July 2014 Jfoi�:` 26, �i9 00283 e1 O1 W CC N CG STATE OF TEXAS CITY OF HOUSTON, TEXAS, USA CERTIFICATE OF DEATH STATE FILE NUMBER 002 1. NAME OF DECEASED (a) FIRST Carolyn (b) MIDDLE Sue (c) LAST i (d) MAIDEN Craig 1 Kruger 4, DATE OF BIRTH November 30, 1946. 8. RACE Caucasian 12. MARITAL STATUS E MARRIED WIDOWED NEVER MARRIED DIVORCED 158. RESIDENCE STREET ADDRESS 14918 Elmont':; Dr. 15c. COUNTY Harris 18. FATHER'S NAME Lawrence G. Kruger 18. PLACE OF DEATH (CHECK ONLY ONE) HOSPITAL: ❑L ItrPATIENT ER/OUTPAT1ENT DOA 19. COUNTY OF DEATH :Harris' 22. INFORMANT- SIGNA i E ELATIONSH 24. METHOD OF DI' POSITION BURIAL CREMATION REMOVAL FROM STATE DONATION OTHER (SPECIFY) 90. WAS THE DECEDENT OF HISPANIC ORIGIN? /ES ENO 31. SIGN TLE OF QERTIFIER 5. AGE (IN YEARS) 56 IF UNDER. 1 YR. MO 9b. IF YES, SPECIFY (MO(CAN, CUBAN PUERTO RICAN, ETC.) 13. SURVIVING SPOUSE (IF WIFE GIVE MAIDEN NAME) Gary D. Craig 15d STATE Texas DAYS IF. UNDER 1 DAY HOURS OTHER: NURSING HOME RESIDENCE OTHER (SPECIFY) 20. CITY OR TOWN (IF OUTSIDE CITY LIMITS, GIVE PRECINCT NO.) HouYbn (Husband) 2S a. PUCE OF DISPs a N MAME OF CEMETERY, CREMATORY OR OTHER CE) Brookside Crematory 26 LOCATION (CITY, STATE) Houston,'Texas MIN 27. SIGNATURE OF FU RA IRECTO,R_OR PERSON ACTING AS SUCH Troy A. Bryant #11144 25b. 10. WAS DECEDENT EVER IN U.S. ARMED FORCES? 23.,MAILING ADDRESS OF 14918 Elmont Section Block Lot Space Unknown 28. DATE OFOISPOSmON 7 7 2003 34. PRINTED NAME ADDRESS OF CERTIFIER Richard Baltz M.D. 800 Peakwood Suite 206 Houston, Texas 77090. 2. SEX Female 6 BIRTH PLACE (CITY STATE OR FOREIGN COUNTRY) Fort Worth, Texas 14e. DECEDENTS USUAL OCCUPATION Supervisor 15e. ZIP CODE 77095 35. PART 1 ENTER THE DISEASES, INJURIES OR COMPLICATIONS THAT CAUSED THE DEATH. DO NOT ENTER. THE MODE OF'DYING SUCH AS OAROIAC OR RESPIRATORY ARREST, SHOCK, OR HEART FAILURE.. UST ONLY ONE. CAUSE ON EACHLINE IMMEDIATE CAUSE (Final disease or condition re 81 g I death) .4 a' r 3. DATE OF DEATH July ,1, 2003 7. SOCIAL SECURITY NO. 11. EDUOATION (SPECIFY HIGHEST GRADE COMPLETED, ELEM. OR SECONDARY (0.12)COLLEGE (1316,17 12 14b. KIND OF BUSINESS OR INDUSTRY. Insurance 15b. CITY OR TOWN Houston: 15f. INSIDE CITY LIMITS YES 1] NO 17. MOTHER'S MAIDEN NAME Norma L. Key 21. NAME OF HOSPITAL OR INSTITUTION (If not in InsteutIon, show street address) Memorial Hermann Northwest Hospital NFORMANT Dr., Houston, Texas 77095 29. NAME ADDRESS OF FUNERAL HOME Praaksitas Funeral Homae Cypress Creak 9149 Highway 6 Nortk Houston. TX 77095 281345.6061 Fax 281.345 -9124 30. CERTIFIER CERTIFYING PHYSICIAN 0 MEDICAL EXAMINER JUSTICE OF, THE PEACE TO THE BEST OF MY KNOWLEDGE DEATH OCCU AT THE TIME, DATE, AND' PLACE AND DUE Td THE CAUSE(S) AND MANNER AS STATED. ON THE BASIS OF EXAMINATION AND/OR INVESTIGATION, IN MY OPINION, DEATH OCCURRED AT THE TIME, DATE, PLACE, AND DUE TO THE CAUSE(S) AND MANNER AS STATED. 32. DATE SIGNED 33. TIME OF DEATH 3:45 p M. sun n Approximate Interval Between. Onset and Deatb' SequenNely list conditions, If an leading to immediate cause, En CAUSE (daces or Inlay drat blasted 'Vents resulting M death) LAST DUET AS A LIKELY CO f EQUENCE OF): DUE TO (OR AS A LIKELY CONSEQUENCE OF): DUE TO (OR AS A LIKELY CONSEQUENCE OF): PART 2 OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING IN THE UNDERLYING CAUSE GIVEN IN PART 1 (I.e., substance abuse, diabetes, emoting, etc.) 37. DID TOBACCO USE CONTRIBUTE TO DEATH YES PROBABLY UNKNOWN 40. MANNER OF DEATH III NATURAL ❑,ACCIDENT SUICIDE HOMICIDE PENDING INVESTIGATION COULD NOT BE DETERMINED 428. REI41STRf11 02. 418. DATE OF INJURY 38. DID ALCOHOL USE CONTRIBUTE TO DEATH ❑❑YES PROBABLY OAT UNKNOWN 41b. TIME OF INJURY 42b. DATE RECEIVED'BVLOCAL REGISTRAR SLY q2, 2pp3 41e. INJURY AT W?RK ❑.YES NO 36a. AUTOPSY? YES 121 NO 36b. AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? ❑IVES 0 N 39. WAS DECEDENT PREGNANT AT TIME OF DEATH., YES }N0 GUNK WITHIN LAST 12 MO YES lean UNK 41d. PLACE OF INJURY -AT HOME FARM, STREET, FACTORY, OFFICE, ETO.(SPECIFTI 41e., LOCATION (STREET AND NUMBER,: CITY OR TOWN, STATE) 41f. DESCRIBE HOW INJURY OCCURRED 42c I ATURE ()VOCAL RiGiSTRAR 13 e t DATE ISSUED 911. 0 3 2003 This is to certify that this is a true and correct reproduction of the original recorias recorded in this office. Issued under authority of. Section 191.051, Health and Safety Code of Texas. -This copy not valid without engraved border displaying seal and signature of the Registrar 4 Wl u son .tier. Greg M. Hinson, Registrar BUREAU OF VITAL STATISTICS 111111111111 11 u itt AL: II Y r sli "1�ws }1 CERTIFICATION OF VITAL RECORD c