HomeMy WebLinkAbout965299State of WY
ss.
County of Lincoln
Janice Yeaman, being first duly sworn upon His /Her oath, deposes and states as
follows:
1.On the 14th Day of January, 2012, my husband, Burnell Yeaman passed
away, as is evidenced by the official certificate of death attached hereto and
incorporated herein by this reference.
2. At the time of death my husband jointly owned certain real property with me,
said real property being located in the County of Lincoln, State of Wyoming, and more
particularly described as follows:
LOT 4 IN BLOCK 1 OF THE FAIRVIEW ADDITION TO THE TOWN OF KEMMERER,
LINCOLN COUNTY, WYOMING, AS DESCRIBED ON THE OFFICIAL PLAT
THEREOF, ON FILE AND OF RECORD IN THE OFFICE OF THE LINCOLN COUNTY
CLERK.
TOGETHER WITH A PORTION OF LOT 5 IN BLOCK 1 OF THE FAIRVIEW ADDITION
TO THE TOWN OF KEMMERER, LINCOLN COUNTY, WYOMING, 1.0 FOOT BY
120.00 FEET RECTANGULAR, MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE SOUTHEAST CORNER OF LOT 5, BLOCK 1, FAIRVIEW
ADDITION, THENCE N 90 °00' W, A DISTANCE OF 1.0 FEET; THENCE N 0 °00' W, A
DISTANCE OF 120.0 FEET; THENCE S 90 °00' E, A DISTANCE OF 1.0 FEET TO THE
NORTHEAST CORNER OF LOT 5, BLOCK 1; THENCE S 0 °00' E, A DISTANCE OF
120.0 FEET TO THE SOUTHEAST CORNER OF LOT 5, BLOCK 1, TO THE POINT OF
BEGINNING.
3. Said real property was originally conveyed to Burnell Yeaman and Janice
Yeaman, husband and wife, as tenants by the entireties, with right of survivorship,
by Warranty Deed, dated October 17, 1973, and recorded in the office of the Lincoln
County Clerk and Ex- Officio Register of Deeds on October 17, 1973, in Book 107 at
Page 516, Document 451089.
4. By reason of Burnell Yeaman death, I am entitled to sole ownership of the
above mentioned real property.
Dated this 1 7
Subscribed and Sworn to and acknowledged before me this
Janice Yeaman.
Witness my hand and official seal.
RECEIVED 6/27/2012 at 12:25 PM
RECEIVING 965299
BOOK: 788 PAGE: 397
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Affidavit of Survivorship
a iziJ1,61A
Notary Public
Commission Expires: �t`�
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00397
CERTIFICATI
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death:
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Cause of Death:
The immediate cause is listed
(a) Respiratory arrest
(b) Pneumoia, .left upper lobe
(c) End stage CORD
Facility:
Certifier:
Type:
Name:
Address:
Date Filed:
607536k
STATE OF WYOMING
Burnell Yeaman
Male Social Security Number:
December 07, 1930 Age at the Time of Death:
January 14, 2012
Georgetown, Idaho
Kemmerer, Wyoming
Married JaniceMarie Rawlings
Yes
Ernest Darwin Yeaman
Ruth T,ippetts
Janice Marie Yeaman
Other Significant
Conditions:'
Manner of Death: Natural Death
This is a true certification of the document on file in the office of Vital
Ei Statistics Services, Cheyenne, wyomingr
DATE' ISSUEDMonday, January 30, 2012
This copy is not valid unless prepared on paper with engraved border.
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
City of Death: Kemmerer
Location: South Lincoln Medical Center PO Box 390'
Additional Decedent information:
County of Death:
Burial
South Lincoln Cemetery, Kemmerer, Wyoming
Ball Family Chapel, Evanston, Wyoming
on the first line followed by any underlying causes.
Physician
Jeremy Starr, M.D.
PO Box 390, Kemmerer,: Wyoming, 83101
January 23, 2012:
2012- 000139
81 years
Lincoln
23 :10 (Actual)`
Thomas 0. Forslund
Director and State Registrar
Arn OA. n ala i. NI l