HomeMy WebLinkAbout967007STATE OF WYOMING
COUNTY OF LINCOLN
David E. Collings, being first duly sworn on oath deposes and say:
1. That David E. Collings is of adult age and is the surviving husband of Kathleen L.
Collings, who died March 23r 2012, in Murray, Utah, as hereinafter more fully appears.
2. That on April 19, 2007 Kathleen L. Collings and I were husband and wife and
intended to take title as tenants by the entireties.
3. That by a Warranty Deed dated April 19, 2007, and recorded April 19, 2007, in the
office of the Lincoln County Clerk in and for the County of Lincoln, State of Wyoming, in Book
655 PR, Page 135, Mark Mackey and Stella Mackey, husband and wife, conveyed to David E.
Collings and Kathleen L. Collings, Grantees, of 296 Lincoln St., Afton, Wyoming 83110, Lincoln
County, State of Wyoming, the following described real estate situated in Lincoln County, State of
Wyoming, to -wit:
Lots 1 and 2 of Lincoln Addition to the Town of Afton, Lincoln County,
Wyoming as described on the official plat filed on January 25, 1983 as instrument
No. 590689 of the records of the Lincoln County Clerk.
4. That Kathleen L. Collings died on the 23r day of March, 2012, in Salt Lake
County, State of Utah, and thereupon, the certificate of her death was duly filed with the State of
Utah and made a matter of record in said office, and a certified copy of said certificate is attached
hereto and made a part of this affidavit.
5. That upon the death of Kathleen L. Collings, as aforesaid, David E. Collings,
surviving husband, became vested with all of his right, title and estate in the above property.
DATED this (90 day of September, 2012.
David E. Collin -s
)ss.
SUBSCRIBED AND SWORN to before me by David E. Collings this ()CPI day of
September, 2012.
NEUENSCHWANIDH W T.AFrl/ PUBLIC
Co ui gty of Stan; of
Lincoln
bllyoming
My Corrunr ul.an August 31, 2014
AFFIDAVIT OF SURVIVORSHIP
RECEIVED 9/24/2012 at 11:59 AM
RECEIVING 967007
BOOK: 794 PAGE: 592
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
A J i"�.�i� Lac i .QJ,
Notary P u lic
1 1,1
1, 1 14. 44
DECEDENT
Date of Death: March 23, 2012
City of Death: Murray
Ade: po
Place of Birth:_ Sacramento, California
Armed Sevides: No
Spouse's Name: David Earl Collings
industryffusiness: Law Enforcemerht
Residence: Afton, Wyoming
Mother's Name: LaNa Hokanson
Facility or-Address: Intermountain MedicaLCenter
'AIV'IVW`oVAW.v. ANI,A,V.PNWAVIvANWI•AW
CERTIFICATE OF DEATH
State File Number: 2012003777
Kathleen LaNa Collings
Fern
Secretaru
HiglfSchool orGED
Grant Allen r
Hospital ER
Time of Death: 20:37
County of Death: Salt Lake
Dateof Birth:
Sex:-
Marital-Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
Name: INFORMATION co
PO Bo726, Afton, VV,yornifig 83
INFORMANT INFO
Mailing Address id Earl ngs
4
DISPOSITION INFORIVIATIOAA'
Method of Disposition: Re_ oval
Place of Disposition: Aftpn,Qarrietery, Afton,
Date of Disposition Athatch2 8,'2012
N FUNERAL. 1-10NIE- INFORIVIATION
'Funeral Home: 4 k Carver fi4Ortuary4,Servi,beILO 1
Address: 5945 Saiuth 350 Murray Utah 607 4
Funeral Director: k,„." Tyler 4Carver
or
MEDICAL. CERTIFIC2k
Certifying PhysicianL-'9 Frank T homas MO,Interniountain Medical _c_ w_ood e Murray:, Utah
84157 1
CAUSE OF DEATH 0'',-, t''
Cardiac arrest ,,•1
l...
Due to or as a consedt,t9nce of): Hypovolemic Hemorrhagic Shock
Due to (oras.adonsequence of) Possible CardiacContusion
fR A
DUe to (or conseque,,pse of): Massive TraurnajnvOlving cbest, and pelvi
s= s ine
Tobacco Use-Did CaRfribute i
Medical Exarniner
es Autopsy Performed: NO Mannerof Death AcPiderit
4
Date of Injury: March23N;012 I -Tirne4dt Injury* 14:51
Injury atWork: No Place.df Injury: High y:-
Location of Injury' Milepost 59.4 Highway 30, Kemmerer' Wyomirlg
How Injury Occurred: Vehiclehit head'on'by-othe,r Vehicle
Motor Vehicle Accident: Driver
Date Issued: March 27, 2012
INJURY INFORMATION
1 pm
`ot
This is an exact reproduction of the document registered in the State Office of vitalfstatistics
Security features of th's official document include Intaglio Border, V R images in cycloids,
ultra violet fibers and hologram image of the Utah State Seal over the words "State al:Rah". This
document displays the date, seal and signature of the State Registrar and the Cointy/District Health Officer.
44,
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Gary Edwards
1(4 `...le:-..... •ot2lo ...a al_Statistics County/Oistrict rtreenf-_
11111N JO gra WM& 1 AI 1JIM. UM VI: IF
4 CERTIFICATION OF VITAL RECORD
-Janice L. HoustOn,State Registrar 0633 7 52E* Dirgotor/HaalltrOfficet S*iikeVal* Heilth DeliaritOnt
Office of Vit
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