HomeMy WebLinkAbout965848File No.: 147629
STATE OF WYOMING
SS.
CO 1 N' OF LINO N
upon `my oth, depose and state:
I,
1. That I am of adult age, a resident of p 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 �c day of 6\ouoct_ca\ \qS3 in Book \\-_3 PR on page
conveys unto \t `vt i c t hX he following described
property, to -wit: `C�w.,� aye ivy ca b\
3. That said Q'1c��\rnwa �gc,.nt1on the day of Cs ■,�c.fu' 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
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$- w t rvn Je g. hL
continuously since the death of the said decedent. ZS�� n(;
FURTHER AFFIANT SAYETH NOT.
Da
Notary Public
Alliance Title Escrow
P O Box 1367
Kemmpr+r WV 83101
State offWyoming)
)ss.
County of Lincoln)
The foregoing instrument was subscribed and sworn to me by
1-; =s i a :r s.:�, Ruby Evans this day of
2444 \-.1 ti
W ness my hand and official seal.
AFFIDAVIT TERMINATING ESTATE
being of lawful age and first duly sworn according to law,
k
LISA M. SPAULDING NOTARY IUsLIC
County of
Lincoln State og
Wyomin
My p 1 w v, O MY Commission Expires July 2015
M Commission Expires: p es Jul 18, 2q
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'99C.Yerw
c oy
C oh may k
RECEIVED 7/31/2012 at 3:25 PM
RECEIVING 965848
BOOK: 790 PAGE: 520
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
147629
EXHIBIT "A"
0052
Beginning at a point 160 rods South and 3 rods East of the Northwest corner of Section 35,
Township 35 North, Range 119 West 6th P.M., in Lincoln County, Wyoming, thence East 37
rods, thence North 13 rods, thence West 37 rods, thence South 13 rods to the place of beginning
CERTIFICATI
ACTION
DECEDENT •NAME
RAYMOND I,VAN WARREN
DATE OF DEATH
FEB. 15, 1984
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
NO
RESIDENCE STATE
WYOMING
FATHER NAME
IVAN WALTER WARREN
MOTHER' -.FULL MAIDEN NAME
ANNIE STUMPP
NAME AND ADDRESS: OF MORTUARY
WOOD FUNERAL HOME, IDAHO FALLS, IDAHO
FUNERAL SERVICE LICENSEE
RALPH M. WOOD
METHOD OF DISPOSITION
R EMOVAL
CAUSE OF DEATH (underlying cause last)
a.
CARDIOPULMONARY ARREST
DUE TO (or: as A: consequence of):
PROBABLE SEPSIS
DUE TO (was a consequence of):
c.
NECROTIZING FASCIITIS
DUE TO (br as a consequence
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting in the underlying cause given above
NONE LISTED
NAME OF CERTIFIER
DATE OF INJURY
DESCRIPTION OF HOW INJURY OCCURRED
PLACE OF INJURY
MARITAL STATUS
MARRIED
BOYD L. HAMMOND., M. D.
SIX
MALE
TIME OF DEATH
10 ?50 P.M.
IDAHO DEPARTMENT OF HEALTH, AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
SOCIAL SECURITY NUMBER
SURVIVING SPOUSE (II wile, maiden name)
TRELMA R.WARREN
CITY, TOWN OR LOCATION
FREEDOM
LOCATION OF INJURY
This is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS.
JUNE 01, 2012
DATE 'ISSUED:
STATE OF IDAHO
MANNER OF DEATH
NATURAL
TITLE OF CERTIFIER
PHYSI :C IANI
u
JAMES B. AYDELOTTE
STATE REGISTRAR
BIRTHPLACE
WYOMING
CITY, TOWN OR LOCATION OFDEATH
I DAH.O
FALS4 IDAHO
BIRTHPLACE
WYOMING
.BIRTHPLACE
WYOMING
HOUR OF INJURY INJURY AT'WORk?
This copy not valid unlessprepared on engraved border
I w" displaying`state seal and signature of the Registrar.
PBNCO4rw101/10 II
AGE
71 YEARS
AUTOPSY
PERFORMED?
NO
I ll
VAL s. AL ITA
ALIT! ID
A L D
;LID
LID
LID
v !F TIAL■D
ALIO
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