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Home My WebLink About966752AFFIDAVIT OF SURVIVORSHIP STATE OF UTAH ss. RECEIVED 9/12/2012 at 10:49 AM RECEIVING 966752 BOOK: 793 PAGE: 738 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 00738 County of Davis I, ROBERT A. ECCEL, being of legal age and being first duly sworn upon oath, depose and state as follows: 1. That I was personally acquainted with JOSEPHINE ECCEL, also known as JOSEPHINE W. ECCEL and JOSEPHINE WILSON ECCEL. 2. JOSEPHINE ECCEL died in Bountiful, Davis County, Utah, on June 19, 2003. A copy of her Certificate of Death is attached to this affidavit. 3. At the time of her death, JOSEPHINE ECCEL owned certain interest in joint tenancy with her husband ARTHUR ECCEL, also known as ARTHUR C. ECCEL and ARTHUR CHRIS ECCEL, located in Lincoln County, State of Wyoming, to wit: Township 19 North, Range 112 West 6 P.M. Section 4: Lot 1, SE1/4NE S'/2S'/2, NW' /4SE% Section 10: S' /2SW NW' /4SW'/4, SW' /4NW'/4 4. JOSEPHINE ECCEL, also known as JOSEPHINE W. ECCEL and JOSEPHINE WILSON ECCEL, the decedent in the attached Certificate of Death is the same person as is named as a party in the Oil, Gas and Mineral Lease dated December 19, 1966, executed by and between Josephine Eccel and Arthur Eccel, her husband, as joint tenants, and recorded March 2, 1967 as entry 400027 in book 77PR, page 315 in the records of the Lincoln County Recorder. 5. JOSEPHINE ECCEL, also known as JOSEPHINE W. ECCEL and JOSEPHINE WILSON ECCEL, the decedent in the attached Certificate of Death is the same person as is named as a party in the Oil and Gas Lease dated March 8, 1972, executed by and between Josephine Eccel and Arthur Eccel, husband and wife, as joint tenants, and recorded March 17, 1972 as entry 437372 in book 99PR, page 14 in the records of the Lincoln County Recorder. 6. JOSEPHINE ECCEL, also known as JOSEPHINE W. ECCEL and JOSEPHINE WILSON ECCEL, the decedent in the attached Certificate of Death is the same person as is named as a party in the Oil and Gas Lease dated February 9, 1977, executed by and between Josephine Eccel and Arthur Eccel, wife and husband, as joint tenants, and recorded March 7, 1977 as entry 490309 in book 134PR, page 423 in the records of the Lincoln County Recorder. 6 Mn ft.” pot l Public Cninmi >sir >n wirniier 676120 0 t .StilS f: c l.)1 13�1 e 7. JOSEPHINE ECCEL, also known as JOSEPHINE W. ECCEL and JOSEPHINE WILSON ECCEL, the decedent in the attached Certificate of Death is the same person as is named as a party in the Restructuring of Distribution of Mineral Rights dated June 10, 1992, executed by and between Josephine W. Eccel and Arthur Eccel, as joint tenants, and recorded June 23, 1992 as entry 750351 in book 312PR, page 21 in the records of the Lincoln County Recorder. 8. JOSEPHINE ECCEL, also known as JOSEPHINE W. ECCEL and JOSEPHINE WILSON ECCEL, the decedent in the attached Certificate of Death is the same person as is named as a party in the Restructuring of Distribution of Mineral Rights dated June 10, 1992, executed by and between Josephine W. Eccel and Arthur Eccel, as joint tenants, and recorded June 23, 1992 as entry 750352 in book 312PR, page 22 in the records of the Lincoln County Recorder. 9. This affidavit is prepared in order to vacate the joint tenancy which JOSEPHINE ECCEL held with ARTHUR ECCEL on the above referenced documents and any interest in the above described property. All interest of the decedent in said property under the joint tenancy indicated above is hereby terminated. DATED this day of ROBERT A. ECCEL ,2012. On this u day of tl- 2012, personally appeared before me ROBERT A. ECCEL, the signer of th within instrument who duly acknowledged to me that he executed the same. 1 �I 1o4 ,.J1(L Q 1 STATE OF UTUTAH DEPARTMEf BATH i► araenn,. oleos w..r eOTIC [`AT>F _C] F n N STATE -SEE 13.. DATE OF DEATH me; :'Zet Y1) 3b TIME OF DEATH 424 N oioWn. 274 DATESI D (Her:, Doh- YMff tg fl 3 3 1• MAME OF DECEDENT FIRST MIDDLE LAST Josephi Wi 1 son ECCEL Femal6 June3 2 2 00 0003 4.. DATE DF9RTH (Ab Day. Yrrl E. AGE. Loa afids r P UMBER t veAR -1: F w GANG 2, Ra 6. -BIRT AFE (CITY 4 SN(4_O RPO' C 41Y 7. 34CIAL MDURITY NUMBER xrelMlr oak RntlaL Jul 1, 1921 81 I i Granger, Wvominq ea PUKE 1 H (rrm A4 OSPITAL .a.4Newer ode I ALL OTHER LOCATIONS: NURSING lb. NAME OF HOSPITAL. NURSG HOM OR OTHER-FACILITY' IY OF OEATN S. NURIn5 Homy e. RR (..-1) roaRNds a M1dR O d irtaMlaaa dlastlerrl, (e o1 1 r VzEReouo.eRi ❑a. DDA Q 7.0111vtspsdyl 237 East 550 North UL, Ba,_CITY TOWN, OR LOCATION OF DEATH 6a_COUNTYOF_:DEATH 0?6U&MR NG SPOUSE 4Maaeetva in.Idell66.') (lr -Arthur= cce1 =8otintiful Davis 124:IOMIO 'OF BIRNESS OR W0 Snot 0 RC E S. FF ORCE67 _�T: Mt4nM 0 3. Weaned _Yea 2. No i III HHT L. 0 O =Bus -iness Manager lakevtew Hospital 2 37 East 550 North 1>a c��m Bountiful M�6x rtv I ,ate cowrtv h 34. INSIDE CITY 13L ZIP CODE 13L RESIDENCE STREET AND NUMBER 11i. WAS DECEDENT OF HISPANIC ORIGIN'? 1. Ws 2. No 16. RAGE- Mad %MINK Am. IOW hgEME. LIMITS?' I (M Yeti Sp30./04 ry) J sa. (BPMEY) I 16. EDUCATION 0.12) G�04(1 }1B a 1, Yo 1. Maxiasn 2. Cahn .;1'W 2 2 _NP 84010 1-0.- 3. P 1.11a ahr(6P�N 17. FATHER'S NAME (Fars. AM ON Last) Martin Wilson INFORMANT Ili 20. METHOD OF DI 1 MP c l 1. 6am11br11entp 4 s° OIsPosn1eN, K Buie, 'b ,Y�Ir June 24,.2003 ,,e'ity,,,,Gemetery ,en River Wyoming e I pece ep ue 24 FUNBRN.110MIEFIlaan anWadReso)_ SAL 1 4 .1,.: L74 2.92 A Lind r#44t .13:011 u M4ttvary#�fr; �c i 213 n ldr Le eta E� Yea aRO p orlh 4i]Q E_ h 1Y L i 1 litah_S401 DERTIF1IR REGISTRAR 5-01 CAUSE OF DEATH. 0 1fi._HAA RELATIONSHIP M1C� MA. AbDR SS OF INF ORMANT `F Arthur ;£CCe1,011, sband/ 23LEOBast f60 t riih,, P" 5.001.POSITION 1214 10MP fTIO I Green River 22 S AT TEND 27a CE P1 2 �dPoa IMMECSA dhows* in death) DATE ISSUED JULY 3 1 2012 ry 20. REGI8TVAJTS SIONA 31. PART' *THE D RE 4-' Saquaraisa l aana, If any. lamellas owe EMSr YING CAUSd( inlwv initiated. events gi p' in death) LAST 34. MNINEROF OEATN Perpeaffei cc Rev. 12166 I Aaddaney ,ii or�T E /y ''0 o' l e y r i9-,.,7,,,N, �I� i( top C anice el .-Houston e �i, f p4 1 'il -State registrar- .1. 4 '1 G.d� i .i ,.i r r rx.., ,.i 1 ,inn_,.,.. a ..u_ el) 0.w%) CERTIFICATION OF VITAL RECORD Ta eta d, MD A- 36a. LOCH ❑3,31tlgtlei TF i. Homidda 6. UM tnM .1wd s. Paver* UGH.BVR 4 Imn4tleall, Farts 12. IrriVrirWAIATAV s =24th. •S•t DUEW, TE OF WJURY (440..32.4 ENCE T6 MAIDEN NAMED MOTHER 47614 ,614:60.4.6 C�cataflaon n e June Woofs nurnfios obemRV4 googly Botint ful Alta h).-� 413i0 N( daa t21a LOCATION- City Tate, Shea L P ART. e. Oda S 0.. d 32 W YOUR OPINION. TOBACCO use tlY THe 0ECEDEI�• 8IR11651000666 In aw1M QIII'M1 5 1. PIeEab antlrLWW to Sat cam d drUL c m4 -T 14, r igaauoolhan 3•. _Y�• k a. FUSER f s. R .wmua tl010. t in d+4tlh- AJ i 7 7M.gua 3 ti2.1N JU .RY AT C+" 1 moo' 0074 8'3 White 12 1 *HO and mod• e141 i et eel 3.1., tee e'a�� Utah= 13440 30a DATEREQUTTRARENOIIFlEO OF DEATH -0Ob. DATE FEED 1-* (1�! e! D.Ytm'L Tune `MODE OF HAS SAND USER ea. Y..S AN PERF and ant 10 the L. Dal/. Yc) 9S2M shed, 361 WdBR,1'4padlYYdwdant Aomoofnaso Ammon 8eM8an Came wet DeFN, This is an exact reproduction of the facts registered;. in_theState Office of m Vital= Statistics.. Security features of this official docuent include: oBorder, V Rimages_n op cyclolds, ultra violet fibers and hologram imageof the Utah ti eal evee=the words"-- State Utah' This document displays the edate, seal signature=�.f S tate Registrar ofYjtaFStatistics. lab. MERE AUTOPSY FINDINGS A,V/1gLABLE ;CAUS S OF IRLETR)N dF CAUSE OF DEATH?' Q 1. Yea Z. No 360 DESCRIBE HOW INJURY OCCURRED (il,Yr awiii of awrRa Mien reauAedAt IRMaY. NATURE OF INJURY anoWd M *Wore dhl iML3t) 11 III 11111111 1 111 1 I II 11 0 6 3 1° 7 3 1'3 UTAH DEPARTMENT OF HEALTH Office�of Vital Records &Statistics- Salt take City =Utah ('l 8 x ia.r Idd .1 I I.i.l .1WJ.IaaJ.i.i i.0 I1.l.IJ.la.l :l.li,11 Ii 1:LLtLraaA. law .I,l,Ia.ia,aa.Id,GDaTGr:LIati.' �h. t/� /f, J \M .gt)Il il 1-t'FTA' v� f# q.11KMV DWI] W MRI p K i ii tai