The URL can be used to link to this page

Home My WebLink About965642-ASTATE OF WYOMING ss. COUNTY OF LINCOLN says: AFFIDAVIT OF SURVIVORSHIP (TERMINATING LIFE ESTATE) Pursuant to W.S. 2 -9 -102 Grace Ellen Merritt of PO Box 458, Thayne, WY 83127, and upon her oath deposes and 1. That MARVIN LAMAR MERRITT, the decedent mentioned in the attached certified copy of Certificate of Death, is the same person as MARVIN LAMAR MERRITT named as one of the parties reserving a life estate in that certain Warranty Deed dated August 5, 1998, executed by Marvin LaMar Merritt and Grace Ellen Merritt, husband and wife, grantors, and recorded September 4, 1998 as Instrument No. 853030 in Book 416 PR, page 785, covering the following described real property located in Lincoln County, Wyoming, to -wit: That part of the SE1 /4SW1/4 of Section 20, T34N, R118W, Lincoln County, Wyoming, being part of that EXCEPTED tract of record in the office of the Lincoln County Clerk in Book 252 PR, page 537, as more particularly described on the attached "Description for Marvin LaMar Merritt and Grace Ellen Merritt Tract C- House" which is incorporated herein by this reference. 2. That the undersigned affiant is the same identical person as Grace Ellen Merritt named as the one of the parties reserving a life estate in the above mentioned Warrant Deed, and that she became on August 29, 2004, the date of the death of the aforementioned decedent, the owner of any interest of MARVIN LAMAR MERRITT in the lands described in the foregoing, subject to any then existing liens and encumbrances, because the decedent's interest in the life estate reserved by said decedent terminated upon decedent's death. DATED the 3rd day of May, 2012. RECEIVED 7/20/2012 at 12:05 PM RECEIVING 965642 -A BOOK: 789 PAGE: 800 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY ,O.Jueue, eitz,,L„ Addi Ade Grace Ellen Merritt 00800 Subscribed and sworn to by Grace Ellen Merritt before me this day of July, 2012. Witness my hand and official seal. GERALD L GOULDING NOTARY PUBLIC County of State of Lincoln X::(-' Wyoming My Commission Expires May 2, 2015 My commission expires: May 2, 2015. 2 NOTARY PUBLIC 0080 _a 1. DECEDENT'S LEGAL NAME (mclude AKA's if any) (First. Middle, last) MARVIN LA:MAR..MERRITT 4. SOCIAL SECURITY NUMBER IF DEATH OCCURRED INA HOSPITAL::: 0Inpalient CER /O Ipatleni ❑DOA :70. FACILITY NAME (II )lnoIAuibn, give :street and numbm) 8. BIRTHPLACE (City and stale or to BEDFORD, WYO 11. EVER IN U.S. ARMED FORCES? OX(ES 0 No 8,.01NDER 8:1088: 9c3)%10 EIn 1 DAT Wined 78. PLACE OF DEATH (Check only one) IF OEATHOCCURRED SOMEWHERE DTNER THAN AHOSP)TAL Hospice Family :Oi4ursing Horde/ Long Tenn'Garef I acllily. Decedent's Home: 00ther (Specgy) 7o. CITY, 30WNS OR LO `CATION'OF DEATH BEDFORD reign eounlry) 9. MARITAL STATUSAT TIME OFDFATN MZNG I led DMenee.)mi saps seed C, •O QNeye Mart ed [7 tldkmYA, 128. RESIDENCE -STATE 120, COUNTY.:'. WYOMING) LINCOLN 3. DATE OF DEATH (Mo/Day/Yr) (Spell Month) AUGUST' 29, :2004 6 GATE OF MATH (MoIDay/Yr) JULY 14, 1924 120. CITY, TOWN OR LOCATION BEDFORD 178.COUNTY OF DEATH LINCOLN 10. SURVIVING SPOUSE (n wife give name prpr lo first marriage) GRACE ELLEN FLUCKIGER LOCAL FILE NUMBER 120 STREET AND NUMBER: Signalure of Carrier 13. FATHERS NAME (First. Middle, Last).,. GEORGE HEBER MERRITT 158. INFORMANT'SNAME GRACE MERRITT' 150 RELATIONSHIPTO:DECEDENT SPOUSE 16. METHOD OF DISPOSITION 21' Bunal 0 Donation 0 Qemeton 0 EnIOmbmegt 0 Removal born Wyom 0 Dthx 120. AC AL s R PRESUMEDTIME OF DEATH 0409 Sequentially list conditions, ilany,' 18b. UOENSENO,;' EM -426 m a) D 2 W 26. WERE AUTOPSY FINDINGS AVAILABLE TO COMPLETE THE CAUSE OF DEATH7. E F- O YES 0 N 21 DATE' PRONOUNCED: DEAD (MNDay/Yr) AUGUST 29, 2004 +DUETO(or 4§,4( s0 nceoly ouercr(nresa onsequ0080088 CAUSE OF DEATH 24. PART I Enler the chain of events diseases, m(urie0 or complications that directly 088.80 Me dea6. DO NOTentertennlnal events such as cardiac 1 respiratory arrest or venlraularbbrlllalonwilhoul ohoWmg the etiology. 00NOTABBREVIATE. Enter mly erecause on a line Add additional lines riemssani. Sys IMMEDIATE resulting CAUSE sease ET P .1- .FAY IMME I TE CAU m •dFina) ;:;DUES r a Ieatl ng to the cause listed on line a a� Enter the UNDERLYING CAUSE b (disease or in)un, Mal Initialed the vents resulting In death) LAST. PART II. Enter other significant conditions contributing to death but not resuhingin the un8RdYlng cause In PHIL 14. MOTHER? 'NAME .PRIOR .TO FIRST MARRIAGE (First, Middle, Last) ETHEL::SPACKMAN 8c. MAIUNG ADDRESS (Street and N mbe tity;Slale, 2p COde)' 3312 CIUNTYTROAD 122 BEDFORD; WYOMIN 17a. PLACE OF DISPOSITION (Name of cemetery or crematory):.. BEDFORD GEMETERY 149., NAME OF FAC)LITY $CHWAB MORTUARY 22. TIME'PRONOUNCED DEAD 0409 7. DID' TOBACCO USE CONTRIBUTE TO DEATH? 17b. LOCATION -CITY OR TOWN A140 STATE BEDFORD. WYOMING 196: ADDRESS OF FACILITY 44; 'EAST F OUR IIf AYE AFTON 23 WAS CORONER CONTACTED Approximate knew% Onset to death 25. WAS.AN AUTOPSY PERFORMED ,,__yyrr O YES LJNO 'V W 28.:IF0EMALE AGED 1084 N 0 0 Not pregnant within past year 0 Not pregnant. but pregnant 43 days to 1 year before death m 0 Pregnant et time /tl death 0 Unknown epregnant the past year F 0 Not pregnant, but bregnantWithin'42 days of death. 30. DATE OF INJURY (MONay/Yr) 375. DATE CERTIFIED (MON8' r) DATE 'ISSUED: CERTIFICATI STATE O F WY W N G DEPARTMENT OF HEALTH 31. TIME:QF INJ4RY STATE OF WYOMING DEPARTMENT OP HEALTH CERTIFICATE OF DEATH 12e. ZIP "(00E', 83112; 29 MANNER OF DEATH:. 21 Natural 0 Accident 2. PLACE OF INJURY (DArxdenl's Hdfne, coRStrue otis le: forest, elc;l' 34. LOCATION OF INJURY (Street and number, Cilyor Town, State) 35. IF TRANSPORTATION ACCIDENT, SPECIFY: 0 Dnver Operator OReclasbian 0 Passengoi O Other (Sp IN 36. DESCRIBE HOW INJURY OCCURRED AND TF TRANSPORTATION INJURY THE YYPE (5)0E VEHICLE(5)INVOLVEO (Aulo bit pickup, mot rcycie bicycle Mb) 37a. CERTIFIER (Check only one) PHYSICIAN -To gm best o1 y kgowl dge dealhbcc Pod at the timMidple and pl8885 and dye lot% ca (Yang rnann hied CORONER; -On the basis oh e8ammal on a n4/80 (9 -1108, M my *ion, deallr ac rred OM the lime dale Od d ace, a4 due ilia 80 tW mannerslated. 95 ti lt This is a true and exact reproduction of the document on file in the office of Vital Records Services, Cheyenne, Morning. EP STATE FILE NUMBER 121.181510E CITY 11M1T5? 0Homicide 0 Pending investigation Ocould not be determined 33.04 /URV AT WORK? 0 YES 0 NO 37 NAME, TITL ANDADDRESS OF CERTIFIER (Type o 94,18) 0 ;`D. PERKES MD' 110 HOSPITAL LANE AFTON, WYOMING 831'10 380 DATE RECEIVED BY REGISTRAR (Mo./Day/VW Lucinda McCaffrey Deputy State Registrar This copy is not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar Pni.Wens' lane elOriON P.0 N- 54146461 Wyo. Pphneen No. 164 MEAD P.plantlon No. Silo Utah N.pbnDon No. 1010 Wads P•yMnbn No. 61444 eee. y.. ee.•wl Wo.6446entIon tie. MO levnPepMipenNe.aox DESCRIPTION FOR MARVIN LAMAR MERRITT AND GRACE ELLEN MERRITT TRACT C HOUSE To- wit: That part of the SEWSWW of Section 20, T34N, R118W, Lincoln County, Wyoming, being part of that EXCEPTED tract of record in the Office of the Clerk of Lincoln County in Book 252 of Photostatic Records on page 537, described as follows: BEGINNING at a spike on the south line of said SEWSWW, S89 47' -34 "W, 485.29 feet from the southeast corner of said SEWSWW, found as described in the Corner Record filed in said Office; thence continuing S89 47' -34 "W, 300.00 feet, along said south line, to a spike; thence N00 06' -33 "E, 145.00 feet to a point; thence N89 47' -34 "E, 300.00 feet to a point; thence 800 06' -33 "W, 145.00 feet to the SPIKE OF BEGINNING; ENCOMPASSING an area of 1.00 acre, more or less; the BASE BEARING for this survey is the east'line of the NEW of Section 20, T34N, R118W, being N00 11' -48 "W; each "spike" marked by a 3/8 "x 12" steel spike referenced by a 5 /8 "x 24" steel reinforcing rod with a 2" aluminum cap in- scribed "SURVEYOR SCHERBEL LTD BIG PINEY WY PLS 5368 with appropriate details; each "point" marked by a 5/8" x 24" steel reinforcing rod with a 2" aluminum cap inscribed "SURVEYOR SCHERBEL LTD BIG PINEY WY PLS 5368 with appropriate details; all in accordance with the plat prepared to be filed in the Office of the Clerk of Lincoln County titled "PLAT OF TRACTS AND BOUNDARY ADJUSTMENT FOR MARVIN LAMAR MERRITT AND GRACE ELLEN MERRITT BRADFORD H. MERRITT AND JODY BELINDA MERRITT WITHIN THE SEWSWW SECTION 20 T34N R118W LINCOLN COUNTY, WYOMING dated 20 April May 1998 lamarc.des OMING 787 0853030 "Modification in any way of the foregoing description terminates liability of the surveyor' 0803