HomeMy WebLinkAbout966207J
File No.: 153100
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,
the 4 day of o oO
conveys unto RU C CLU-e L
property, to -wit: c,
3. That said Donald Larson on the '7 day of en died and a
copy of the original certificate of death, certified to a 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 Donald Larson 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 Pe ak/vit.
continuously since 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 2 day of
August, 2012
Witness my hand and official seal.
0\
Notary Public
My Commission Expires: A. X043,
Alliance Title Esc
PO Box 1367
Kemmerer Wv /311f11
AFFIDAVIT TERMINATING ESTATE
RECEIVED 8/15/2012 at 3:40 PM
RECEIVING 966207
BOOK: 791 PAGE: 664
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Wyoming is recorded a Warranty Deed dated
in Book .950 PR on page 0/ A
the following described
LISA M. SPAULI IN
County of
Lincoln
NOTARY PIXILIC
State of
Wyoming
My Commission Expires July 18, 2015
Date Filed
STATE :OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
CERTIFICATE OF DEATH
JANUARY 18, 2
DECEDENT LEGAL NAME
DONALD HEPWORTH LARSON
SIX SOCIAL SECURITY NUMBER AGE DATE OF BIRTH
MALE 91 YEARS APRIL 2D,1919
BIRTHPLACE PLACE OF RESIDENCE
AFTO.Nr` WYOMING PRESTON, IDAHO
MARITAL STATUS'AT TIME OF DEATH NAME OF SURVIVING SPOUSE (P
NAME.AND ADDRESS OF FUNERAL FACILITY
SCHWABM.ORTUARY,!AF•TON, WYOMING
DATE OF DEATH TIME OF DEATH CITY,TOWN OR LOCATION OF DEATH COUNTY OF DEATH
JAN.. 17, 2011 7:22 A.M. PRESTON, IDAHO FRANKLIN
CAUSE OF DEATH (underlying cause last) Appro7tlmate:tnterval Between
Onset and Death
a.
CARDIAC ARREST SUDDENLY
DUE TO or as a oonsequenoe ot)::
b. UNKNOWN
DUE TO (or as a consequence N):
DUE TO (or as gonsequence of);
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting in the underlying cause, given above WAS AN AUTOPSY
PERFORMED?
NONE STATED NO
MANNER OF DEATH NAME OF CERTIFIER TITLE
NATURAL DAVID B. BECKSTEAD, M.D. PHYSICIAN
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
GATE OFIWURY:% TIME OFINJURY PLACE OF INJURY INJURY AT
WORK?
:LOCATION WHEREINJURY:OCCURRED
\AA%111
GAT_ i241 1 L11
9 K0 no At 1 t
f �''y JANUARY 18, 201 j l k
)4 4 1, Or DATE ISSUED:
7. i JAMES B. AYDELOTTE
Ki This c opy n valid unless prepared on engraved border
t' T displaying state seal and signature of the Registrar, STATEREGISTRAR! y
`4/_— PIKO Otev107 /10
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.
STATE OF IDAHO
00665
2 00
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.
u0666
Subject, however, to all reservations, restrictions, exceptions, easements and rights -of -way of record or
in use.