HomeMy WebLinkAbout965473Affidavit of Survivorship
I, Geraldine Clarke, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date of December 5, 1995, for valuable consideration, Frances A. Gordes, a
single person, by deed of that date, which deed was duly filed of record in the Office of the Lincoln
County Clerk, on December 5, 1995, in Book 377PR, Page 199, conveyed to Frances A. Gordes,
Elaine Celli and Geraldine Clarke, as joint tenants, the following described land, in the County of
Lincoln, State of Wyoming, to -wit:
That part of Lot 4 of Block 6 of the Town of Kemmerer described as follows:
Beginning at a point 100 feet southerly from the northwest corner of said Block 6 and running
thence southerly on Cedar Avenue 4o feet;
thence easterly 140 feet;
thence northerly 4o feet;
thence westerly 140 feet to the point of beginning, being a rectangular plot 4o feet fronting Cedar
Avenue by 14o feet adjoining Lot 5 in said Block 6
That by reason of said conveyance aforesaid, the said Frances A. Gordes, Elaine Celli and
Geraldine Clarke, as joint tenants, became the owners of said real property, and the title thereto
vested in them continuously from the date of said conveyance, to the date of death of Frances A.
Gordes, also known as Frances Ann Gordes, on the 8th day of October, 2011. That by reason of
and upon the death of Frances A. Gordes, also known as Frances Ann Gordes, title in the above
described real property vested in Elaine Celli and Geraldine Clarke, as joint tenants.
Affiant avers and certifies that Frances A. Gordes, also known as Frances Ann Gordes, is
the identical party named with Elaine Celli and Geraldine Clarke in the aforementioned deed,
whose death terminated her interest, title and estate in said real property; and Affiant attaches
hereto, and makes a part of this affidavit, a copy of the Official Certificate of Death of said
decedent, duly certified by the public authority in which said death certificate is a matter of
record.
Dated this day of
State of r utit
ss.
County of Lt Is-Vir D
2012.
Geraldine Clarke
Subscribed an sworn to before me, a notary public in and for said County and State, by
Geraldine Clarke, this day of o 2012.
WITNESS my hand and official seal.
I
i(ti Expires: Qdi aDt
RECEIVED 7/10/2012 at 3:56 PM
RECEIVING 965473
BOOK: 789 PAGE: 291
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Notary Public
00291
1
bun
Other Significant
Conditions:
Manner of Death
Decedent: State File Number:
Name: Frances Ann Gordes
Gender: Female Social Security NUmber:
Date of Birth: November 24, 1915 Age at the Time of Death:
Date and Place of Death:
'Date of Death: October 08, 20.11 County of Death:
City of Death: Kemmerer
Location: South Lincoln Nursing Center 711 Onyx St
Additional Decedent Information
Place of Birth: Aurora, Minnesota
Residence: Kemmerer, Wyoming
Marital Status: Widowed
Armed Forces: No
Name of Father: Anthony Borstnar
Name of Mother: Frances Perushik
Informant: Geraldine Clarke Relationship:
Disposition:
Method of Disposition: Cremation
Place of Disposition: Garner Crematory, Salt Lake City, UT.
Funeral Home or Facility:
Facility: Ball Family Chapel, Evanston, Wyoming
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes. Interval:
,(a) Multisystem Organ Failure Weeks
Vi n,. 590344
Natural Death
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Certifier:
`:Type: Physician
Name: George C. Krell, M.D.
Address: PO Box 390, Kemmerer, Wyoming, 83101
Date Filed: October 28, 2011
This is a true certification of the document on file in the office of Vital
Statistics Services, .Cheyenne, Wyoming.
DATE` ISSUED: Monday, October31 2011_''
,This copy, is notvalidenlesa prepared on•paper within engraved border.
00292
2011- 003217
95 years
Lincoln
Daughter
15:40 (Actual)
Thomas 0. Forslund
Director and State Registrar
CERTIFICATION OF VITAL RECORD
Y