HomeMy WebLinkAbout966198Recording requested by:
Wells Fargo Bank, N.A.
A Recording Return
Wells rgo Ban .A.
Attn: Do t Mgt.
P.O. B 1 MAC B6955 -013
gs, MT 59 7 -9900
WYOMING
Account Number: 682- 682 0988618 -1998
Reference Number: 20121117700068
COUNTY OF LINCOLN
ldenti /Survivorshi Aff, CDP.V1 (Feb -05
11111 ii i1111111u1111iiii
AFTER RECORDING, RETURN TO:
AMERICAN TITLE, INC.
P.O. BOX 641010
OMAHA, NE 68164 -1010
ATI# cal o �`��'JC
Space Above This Line For Recording Data
AFFIDAVIT OF IDENTITY AND SURVIVORSHIP
00 637
RECEIVED 8/15/2012 at 2:43 PM
RECEIVING 966198
BOOK: 791 PAGE: 637
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING NAME OF DECEDENT
VERA B ROOT
1, EUGENE ALBERT ROOT being first duly sworn, on oath state from personal knowledge:
That the above named decedent is the person named in the certified copy of Certificate of Death attached hereto and
made a part hereof.
That the name(s) of the survivor(s) is /are EUGENE ALBERT ROOT.
That said decedent on date of death was an owner as a joint tenant/life tenant of the land, legally described as
follows: THE NORTH ONE -HALF (N1 /2) OF THE FOLLOWING: BEGINNING AT A POINT 24 FEET
SOUTH OF THE NORTHWEST CORNER OF LOT THREE (3), BEING THE NORTHWEST QUARTER
OF THE SOUTHWEST QUARTER (NW1 /4 SW1 /4), AND RUNNING THENCE EAST 300 FEET;
THENCE SOUTH 290.4 FEET; THENCE WEST 300 FEET; THENCE NORTH 290.4 FEET, TO THE
POINT OF BEGINNING, ALL IN SECTION 7, TOWNSHIP 34 NORTH, RANGE 118 WEST OF THE 6TH
P.M., LINCOLN COUNTY, WYOMING.
as shown by instrument recorded in Book N/A of Page N /A, or as Document No. N/A in the office of the County
Recorder of RECORDER County, State of WYOMING, or as shown on Certificate of Title No. N /A, Files of the
Registrar of Titles of LINCOLN County, State of WYOMING.
E qq A \burr gOf
Signature of Affiant
1/2
Documents Processed 07 -19 -2012, 08:10:44
ACKNOWLEDGEMENT:
(Individual)
State of W C1 0 r(\l q
County of t- (t\-) 0 0 L N
(Seal)
ss.
ss.
On this 2D day of OJ ll
appeared i t .19PnP RItPr-t Roof
(Name(s) of Person(s) Acknowledged) who, I am satisfied, EUC
the maker(s) of the instrument, and acknowledged that
20 '2_— before me personally
638
41 ature o
ne I-likorf Roe,+
was executed as the make s own act.
SHERYL MANNING NOTARY PUBLIC
County of
Lincoln e ar. 1 State of
Wyoming ry,�
My commission Expires 1 2-0 3 7 c
My commission expires:
Ideati /Survivorshi Aff, CDP.VI eb -05
(Print o ype Name of Notary Public)
2/2
Documents Processed 07 -19 -2012, 08:10:44
Decedent:
Name:
Gender:
Date of Birth:
Date of Death:
City of Death: Thayne
1982 MuddyString.l3d.'.
Additional Decedent
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Other .:Significant
Conditions:
Manner of Death:
'Certifier:
Type:
Name:
.Address:
Date Filed:
Information:
Thayne., Wyoming
Thayne, Wyoming
Married `Eugene Albert Root,
No
Pearlie Cox
Mattie Cleo "McDonald
Eugene Albert Root, Relationship"
Vera Belle Root
Female Social Securiy Number:
October 29, 1933 Age at the Time of Death:
April 30, 2011
May 07, 2011
Wit,
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Facility: Schwab Mortuary, Afton, Wyoming
This is a true certification of the document on file in the office of Vital
4 Statistics Services, Cheyenne, Wyoming,
4, DATE ISSUED: Monday, May 09, 2011
CG
This copyis not.ynlid unless prepared on paper with an engraved
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Cremation
Schwab Mortuary Crematory, Afton, Wyoming
Cause ofDeaths
The immediate cause is liked on the first fine followed'by any underlying cause's.
(a) Alzheimers Dementia
Physician
Christian M. Morgan, M.D.
110 Hospital Lane, "PO Box 579, Afton, Wyoming; 83110
County of Death:
77 years
Husband
08:04 (Actual)
2011- 001322
Gladys K. Breeden i
Deplty State Registrar