HomeMy WebLinkAbout966719STATE OF WYOMING
SS.
COUNTY OF LINCOLN
I, Donald J. Weidler being of lawful age and duly sworn according to law upon my oath and
depose and state:
1. That I am of adult age, a resident of Columbia, Kentucky, and the Affiant herein.
2. That by virtue of the conveyance which is recorded in the Office of the Clerk for Lincoln County,
Wyoming, located at Kemmerer, Wyoming in Book 629PR, Page 512 is recorded a Warranty
Deed dated June 26, 2006, which conveys unto Mayra A. Baez and Donald J. Weidler, as Joint
Tenants, the following property more particularly described, to -wit:
Lot 42 of Stewart Country Club Estates Phase 2, Lincoln County, Wyoming as
described on the official plat thereof.
3. That by virtue of the conveyance which is recorded in the Office of the Clerk for Lincoln County,
Wyoming, located at Kemmerer, Wyoming in Book 629PR, Page 513 is recorded a Warranty
Deed dated June 26, 2006, which conveys unto Mayra A. Baez and Donald J. Weidler, as Joint
Tenants, the following property more particularly described, to -wit:
Lot 43 of Stewart Country Club Estates Phase 2, Lincoln County, Wyoming as described on
the official plat thereof.
4. That by virtue of the conveyance which is recorded in the Office of the Clerk for Lincoln County,
Wyoming, located at Kemmerer, Wyoming in Book 769PR, Page 646 is recorded a Warranty
Deed dated July 16, 2011, which conveys unto Donald Weidler and Mayra Baez, husband and
wife as tenants by the entireties, the following property more particularly described, to -wit:
Lots 27 and 35 of Star Valley Ranch Plat 9, Lincoln County, Wyoming as described on the
official plat thereof.
5. That said Mayra A Baez died on the 1 lth day of September, 2011, and a copy of the original
certificate of death, certified to an 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 Mayra A Baez and by reason of state statutes, the decedents
interest and title in said property has terminated and title to the real property conveyed thereby has
vested absolutely in Donald J. Weidler continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
Witnessed my hand and official seal.
Commission Expires:
AFFIDAVIT
0 0642
Donald J. Weidle
1 The foregoing instrument was subscribed and sworn to before me by Donald J. Weidler this
--day of September, 2012.
Notary Public
RECEIVED 9/10/2012 at 4:50 PM
RECEIVING 966719
BOOK: 793 PAGE: 642
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
tasea' •71k,
FILE Qlw„
D: CPN175 NOM
3.rbAt E (A1014h, Dey, Yea� r)
July 11. 1949
6, SOCIAL SECURITY NUMBER
7. BIRTHPLACE{ Dji
a
PUCE OF DEATH HOSPITAL: .r Inpal sni ll u l
NON•HOSPITAU Hospice FaOI0
10, FACILITY NAME Of not institution, give sfreetaddress),'
Kindred-Hospital
2. MARITAL STATUS (Specify): d
Monied Married, but Separated Widowed Xi DIvarced, 1_
4a RESIDENCE STATE 14b, COUNTY;1
Florida Broward
14d STREET ADDRESS
8280 Sunrise Lakes Blvd
DEi0R S „A C (Spec(( (he )aca/re 1 lndlcale wh @l decedent conslderedheiteelpherselflope Moriajee one` reeiiiney be speclged.)>t
Ih" I g)ack dr P noan American` Amerkee lndla0 or AIes n Naltutr (9pecrty ilibe) I.
A9lan lndielt Oh1ne�6 ell p190 Japanese l <'sa� r r s Via amese
1
Hew L uernerllan or Chamorro _Samoan �CjheAPachtO leL (Gpafe7y")1
17:,DECEDENT OF HISPANIC OR HAITIAN ORIGIN? :4
Vas (Ir 'es speedy) _7
(y was of Hispanic or Heltlan Origin.)
.•I rllwmli
18. DECEDENTS EDUCATION (9peclfy,the eleceo'nf s Mghe 0egree dNY#el o /SY"SYih
6M or less High school bye no d(ci r ma
_college but .no de ree College de ree
20, FATHER'S NAME (Fist, Middle, Lest; Suffix):
Rene Arbor
225. INFORMANTS NAME
Donald Weider
23b' OR TOWN
Sunrise
24. PEACE OF DISPOSITION :(Name ofcemelery, crematory, er, Olerplecs)
Boyd Cemetery
26efMEfHOD OF'DISPOSITION
J Abb ,0EM ,DICA N, AN R SEA
�1'V ,�I;Y U'l I —No
iI F I IFUNEpAlgOACILITVI
aM�h Adritation tLtrteeal Hom
I i1'tation
k"QERTIFIER: CedNylhg
(CheEb,one)
31 S; (Pighatur, and.
IC?H /C /A1
340 LICENSE NUMBER"
M .CIb4
365, CERTIFIER'S
Florida
37, '8 ctST R
11" 'a vAll
49b; CITY OR TOWN
ERTIFfE
'FLORIDA CERTIFICAT O F DEATi
Mi441@ Lahr su7(k)
A.
290 STREET ADORESS
70,01NW4i0tt ;4
Ph ia
yeklah'• To the be6lpl my 0,"°' etl�e� ea`ikl �b e �rlr`' 1 I da 3h0
a 1 a t4 b,5 •r II nI Wd"
o Mr -On the basis bl' pxaminaliol <)afiidll,frJrWe`q'Ip rrr�r0a I"�(!
41. CAUSE OF DEATH PART I.
(See Instructions on back)
IMM D CAUSE
AStlktn 1�1Idp�Ih)
egyentto4y l)$t,cont 9(4ns
i p l ti y,
II sl 'I I EnleK'Ihe
IN R.T h NGCAUSE
�(dfs hliluryander
:Ihl„ieled °the. events
re3 Sing in death) LAST
6T 36b. CITY OR TOWN
Ft. Lauderdale
SI• nature arx(Date
50. DESCRIES HOW INJURY OCCURRED
PARTS. Other:yl5nlecant conditions conmbulinc l0 death bl)t no("resuttlp3
46.1F;FEMALE, WAS SHE PREGNANT WITHIN THE PAST YEAR
Yes _No X Unknown 11,Yee, spedy limeltame
40 GATE OF INJURY (Month,. Dee. Year) 47. TIME 010 INJURY (24 ht.)
.40. UNOER:..1
49c STREEYADDRESS
EivATTO S fj l7 f? ECE
I
r�nSesti'c Feltner
23o. STREET AOORESS
8280 Suhnse.Lkes BtYd;)i #1'
26a LOC, T ON` STATE
1ovua
Entejnbment 'Ore, etbn I �w 'Ype(,� Xellrpto Siale Nl Olh� ':(4k64 270 UCENSE •NUtg1BER (of Ckarrls@e) 27b SI RE OE V(CE PERSON AOfING A$.
r ,,,,..a i
r�. •.,�.�9 Tn�E u
rA.
43a. IF SURGERY MENTIONED IN PART I OR 11, ENTER REo,p 9 FOP pURG InY 430. OPI t f
k l �h4�' ,nl;Tr °!c
t aet
467UN0ER 1,DAY
a4t /16u4017',"; t lfMln0fes 1
ni I�11�N id i l`. I
MENT IS PRINTED OR_ PHOTOCOPI O7ONSF
A E IVI,TT61
EAL OF THE 'STATE OF FLORIDA, DO 'NOT AO'DEPT WII uT E I 15.15:1110
HE DOCUMENT FACE" CONTAINS A'I .MUL,TI COLD, eW Gri0UNDAAND GO
CONTAINS SPECIAL LINE'S WITH TEXT ANDS ShN E xfOMtC" 14k
Latdedlf
VfVINQ'S 0!tM1
51 'r1In 42days01d@9 },A
49a. LOCATION'OF,iINJU M
":'!CERTIFICATION OF VITAL
5DA OF DEATH (Morita, bay; Year);
:SebteMber 29 20;1'1
i�Nl'IIf OF OEATH', l
toward
[tipie', Other (Specify)
1011.0E DEATH
other ;41�A (Speciry)
r .='Olher'(Sp ec i6o) i,
Cubai
ACILtTYS AILIN
yln� ,cg usQ(a)endmeiinerslaied; `'I`
W4r1�
date
and piece due to Me rause(a) and manner slated.
,1',14 (24 hr.) 33.MEDIOAL EXAMINER'S CASE NUMBER
L.
I AMEOk,IATTENDING PHYSICIAN '(ll l renCeldl(er)
30 PROBAB ANNER OF DEATH following are'under ma )u Ol the medbal 0Aarm(lal f r•
Natural i Accident Sui1We r F(omkye F@ aeilgakee Utldel rmipad
4
Enter chain 'of events diseases In)Udes or Icadon@ I t 1
N O lase(' v1 04psedrhbdaello thr 0 00 h e5 ne
DO N enter t �Ifnal eva`nl such as card iao arrest fesplrato0i 0 o vents filar 00., (iI a howlhgwing M @�el(obgy
-rr 0 e-1 1 i. •r:..
ANSPOR 62E St4hlsof Deadest r r
o n p a _Diver Operator T PessOnger PerleStdegh1
(SPeCN) �y
1 o�t)e(lel�I Cai41161yan I S U V I4 (l 0 Pi c k up ?nk go Va B Hea Tratla n o1Mar s
19, WAS DECEDENT:EVER 1W%
U.S. ARMEb FORCES?
MRD
„YSEF DAT(1�
1:gb: INSIDEI0ITY LIMITS.?
thin; 43 daya41 g0 ordeals
360: ZIP CODE
P,\00 333 6"
as
33�1i7n
)oximete Inler✓l,91:
Onset'to Death
r 4,019T013ACCC: USE'CONTRIBUTE 70 DEATH?'
{i v 'Yes No Probably Unknown
1 AN AUTOPSY 420. WERE AUTOPSY FINDINGS AVAILABLE
ER FORMED? TO COMPLETE THE OAUSE OF`DEATH
51Ag27/.n
ATERMARK,OF,7HE GF�EAT
E OF`TH WATERMARK
EMH08ED SEAL. THE BACK
1 1
1
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