HomeMy WebLinkAbout966206File No.: 153100
alliance Title Escrow
PO Box 1367
a <a- rnrnorer WY 83101
STATE OF WYOMING
SS.
COUNTY OF LINCOLN
I, Chet Laval Larson, being of lawful age and first duly sworn according to law, upon my oath,
depose and state:
1. That I am of adult age, a resident of Evanston, Wyoinin, 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
the2( /0 day of a in Book Sig PR on page 0 a
conveys unto aem.. d€Z.u. o—a the following described
property, to -wit: c
3. That said Gustav T. Larson on the day of 97' 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 Gustav T. Larson by reason of 2 -9 -102 W.S. (1980), the
decedents interest and title in said conveyance has terming ed and title to he real property
conveyed thereby has vested absolutely in
continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
Chet Laval Larson
State of Wyoming)
)ss.
County of Lincoln)
The foregoing instrument was subscribed and sworn to me by Chet Laval Larson, this 2nd day of
August, 2012
itness my hand and official seal.
Notary Public
My Commission Expires:
AFFIDAVIT TERMINATING ESTATE
USA M. SPAULDING NOTARY PUBLIC
County o f State of
Lincoln Wyoming
My Commission Expires July 18, 2015
00661
RECEIVED 8/15/2012 at 3:37 PM
RECEIVING 966206
BOOK: 791 PAGE: 661
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
IArloE 1 F II)AHO
CERTIFICATI I ITAL RECORD
Date;Filed
DECEDENT• NAME
FEBR VARY ;:12, 199
GUS T ":LARSON
WAS DECEDENTEVER1N::
U.S. ARMED FORCES
NO
MOTHER FULL MAIDEN NAME
MERTAL:STATtUS
WIDOWED
NAME AND.ADDRF:.SS,QFtutOFTJ'119fN
MATTHEW:S MORTUARY, INC., MONTPELIER, ?IDA1O
FUNERAC'SERVICE LICENSEE'
LEONARD H. MATTHEWS
METHOD .OF L11S POS ITIOtC
REMOVAL
CAUSE OF DEATHs (underlying cause last)
PNEUMONIA ;:RESP ARREST
DUE TO (or as a consequence of):
DUE TO (or as a consequence of):
d.
OT1 SIGNIFICANT•:CONDITIONS CONTRIBUTING TO DEATH but not resulting in the underlying cause given above
NONE LISTED:
NAME:OPcErn IFIER
NOALL E. WOLFF, M.D.
'MALE
DATE OF INJURY 40 HOUR OF INJURY
:STATE cF DAHo:
`IDAHO DEPARTMENT HEALTH ANO.VELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
SOCIAL SECURITY. NUMBER
SUR/IVING SPOUSE (If sole, maiden name)
LOCATION OFINJURY
AUGUST °08, 20:.12
DATE ISSUED.
This copy not valid unless prepared on engraved border
dlspiaytng State Seal antl sIgnature.of the Registrar.
DATE OF BIRTH
:S
\\11,`t This is a true and correct reproduction of the document officially registered and placed
g
S S fry t on file with the IDAHO BUREAU OF VITAL_ RECORDS AND.'HEAL'TH STATISTICS.
I
O
"1114,00
pp 1
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Pi 11 r
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IP
23, 1891
MANNER QF:DEAT
NATURAL
JAMES:- AYDELiT:`T`E
STATE REGISTRAR
State File No 1992 00695
NORWAY
CITY.TOWN.OR LOCATION:OF DEATH:
TITLE OF CERTIFIER
BIRTHPLACE
BIRTHLACE
;NORWAY.
Approximate Interval Between
Onset and Death
7?DA S
ihLURY.AT Rkr
ATTACHED EXHIBIT "A"
LOT NO. 3 OF BLOCK NO.1 TOWNSITE OF GROVER, LINCOLN COUNTY, WYOMING.
Together with all water rights, mineral rights, improvements and appurtenances thereon situate or in
anywise appertaining thereunto.
00663
Subject, however, to all reservations, restrictions, exceptions, easements and rights -of -way of record or
in use.