HomeMy WebLinkAbout967017Affidavit of Survivorship
I, June May, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date of March 23, 1994, for valuable consideration, Ronald B.
Uhles, a married man as his sole and separate property, by deed of that date, which deed
was duly filed of record in the Office of the Lincoln County Clerk, on April 4, 1994, in
Book 347PR, Page 62o, conveyed to Gerald May and June May, husband and wife, the
following described land, in the County of Lincoln, State of Wyoming, to -wit:
Situated in the Town of Diamondville, in the SE1 /4SE1 /4 of Section 23, Township 21
North, Range 116 West, 6th P.M., described in particular as follows:
Beginning at a point which is North 74 °02' West, 352.9 feet from the Southeast corner of
said Section 23 which point is the Northeasterly corner of Parcel numbered Seven (7) of
the Town of Diamondville, and the Southeasterly corner of said Parcel numbered Six (6);
thence South 78 °57' West, along the boundary line between said Parcels Six (6) and
Seven (7), 126.5 feet to a point which is the Northwesterly corner of said Parcel Seven (7)
and the Southwesterly corner of said Parcel Six (6); thence North 9 °40' West, 53.0o feet
to a point which is the Northwesterly corner of said Parcel Six (6) and the Southwesterly
corner of Said Parcel Five (5) of the said Town of Diamondville; thence North 78 57'
East, along the boundary line between said Parcels Five (5) and Six (6), 126.5 feet to a
point which is the Southeasterly corner of said Parcel Five (5) and the Northeasterly
corner of said Parcel Six (6) which point is North 66 °47' West, 378.85 feet from the
Southeast corner of said Section 23; thence South 9 °40' East, 53.00 feet to the point of
beginning.
Beginning at a point North 74 °2' West, 359.2 feet from the Southeast corner of said
Section 23; thence South 9 °40' East, 47 feet; thence South 78 °57' West, 126.5 feet;
thence North 9 °40' West, 47 feet; thence North 78 °57' East, 126.5 feet to the place of
beginning.
Beginning at the Northwesterly corner of Parcel Six (6) described above, which is also
the Southwesterly corner of Parcel Five (5) of the Town of Diamondville; thence South
9 40' East, 100.00 feet along the westerly property line of Parcel Six (6) and Parcel
Seven (7); thence South 78 °57' West, 100.00 feet; thence North 9 °40' West, 100.00 feet;
thence North 78 °57' East 100.00 feet to the point of beginning
That by reason of said conveyance aforesaid, the said Gerald May and June May,
husband and wife, became the owners of said real property, and the title thereto vested
in them continuously from the date of said conveyance, to the date of death of Gerald
May, also known as Gerald Edwin May, on the 15th day of July, 2011. That by reason of
and upon the death of Gerald May, title in the above described real property vested in
June May.
Affiant avers and certifies that Gerald May, also known as Gerald Edwin May, is
the identical party named with June May in the aforementioned deed, whose death
terminated his interest, title and estate in said real property; and Affiant attaches hereto,
and makes a part of this affidavit, a copy of the Official Certificate of Death of said
RECEIVED 9/24/2012 at 2:21 PM
RECEIVING 967017
BOOK: 794 PAGE: 612
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
1
decedent, duly certified by the public authority in which said death certificate is a matter
of record.
Dated this 2 day of 20 2.
/3 ?7 a
06.
June May
State of da
ss.
County of 1�'r.rr
Subscribed and sworn to before me, a notary public in and for said County and
State, by June May, this /OM day of jep -Lem he 2012.
WITNESS my hand and official seal.
ri J. CLARIZ PEREZ
(4 °_e COMM. #1931650 44
NOTARY PUBLIC CALIFORNIA m
PI KERN COUNTY me'
My Comm. Exp. =0 2015
My Commission Expires: f' )pi-i .70/5
2
D
21. CITY
BAKERSFIELD
22. COUNTY/PROVINCE
KERN
23. ZIP CODE
93306
24. YEARS IN COUNTY
64
25. STATE/FOREIGN COUNTRY
CA
Q t
i
2 f.
WAN DA JUNG MAY, SHIP WIFE
27. INFORMANTS MAIUNG ADDRESS (Street and mlmbar, or m14 KM. number 1080, to andzip)
14513 CASITAS CANYON ROAD, BAKE CA 9
Z
Q'
a D
26. NAME OF SURVIVING SPOUSE/SROP• -FIRST
WAN DA
29. MIDDLE
JUNE
30. LAST (BIRTH NAME)
EDWARDS
31. NAME OF FATHER/PARENT -FIRST
ERNEST
22: MIDDLE
COY
33,IA5'T
MAY
34: BIRTH STATE
MO
3 U
i.
35. NAME OF MOTHER/PARENT -FIRST
STELLA
38. MIDDLE
MAE
37. LAST (BIRTME)
H NA
UHLES
38. BIRTH STATE
AR
a
U a
39.DiSPOSmONDATE mm/dartiyy
07/20/2011
dD.PLACEOF FINAL plsposmDN HILLCREST MEMORIAL PARK
9101 KERN'CANYONRQAD, BAKERSFIELD, CA 93306
G tl
41. TYPE OF DISPOSITION(S)
BU
42. SIGNATURE OF EMBALMER
MICHELLE VANRENSSELAER
43. LICENSE NUMBER
EMB8291
2.
44. NAME OF FUNERAL ESTABLISHMENT
HILLCREST MEMORIAL PARK AND
MORTUARY.
45. UCENSE NUMBER
F01162
46. SIGNATURE OF LOCAL REGISTRAR
CLAUDIA JONAH, MD
d/cc
47 DATE mnVdW
'07/19/20.11.
w
O Q
101 PLACE OF DEATH
GLENWODENS
OD GARDENS
104.
102. IF HOSPITAL, SPECIFY ONE
w0P
103.1F OTR 11
TE4AN (HOSPITAL, SPECIFY ONE
FbapKe X (g mATC Home an.
6.
COUNTY
KERN
105 FACIL17YADORESS OR LOCATION WHETS FOUND (Seem and number, or location)
350 CALLOWAY DRIVE'-
'ALAN
BAKERSFIELD
107. CAUSE OF DEATH Enter On chain ofevent diseases ntJnes or cdnplkalbns Mal'dyedly caused death DO NOT eMer lermnal meals sudi
as cardiac arrest, reeprabry mast, or ventriciderilbellalion weep.. spewing to etiology. DO NOT ABBREVIATE'
IMMEDIATE CAUSE CARDIORESPIRATORY
Time Ogg Itehveg
Dme(and Dealb
111 CRN F6V11®10C7ChER1
YE X NO'
sew
evawmeM
(a FAILURE
(Final disease or N)
ebndbloh'seeding--1 MIN
META S TATIC PROSTATE CANCER NU
Sequential* any.
l aatlb9t 1 i MT HS'
109, BIOPSY PERFORMED?
YES X ND
8
r''
N
ci
on L M A. Enter Cl
JNl'We Y:NG
CAUSE (disease or
1"
110 AUTOPSY PERFORMED?
NO
YES
In lhe events A
resulting M death) LAST (DT)
11 1.11SEOINTIETERMN5GCAU0E7
10
112. N E SIG141FICANT CONDITIONS CON1AIBlIRNG TO DEATH BUT NOT RESULTING IN THE UNDERLYMD CAUSE GIVEN IN TOT
NONE
113. WAS OPERATION. PERFORMED FOR ANY CONDITION IN 11E M1 OR 1127 (It gs, Mt type oropau80n and dale)
NO
113 F EBAN.E PFfEL740(4T NIASr1'FNi7
?Es IN No UNT
Z o
m F
N a o
F
I N
11t WII
ICEFOWY11O11EEES7CF MYKADY4IDCEDFA7HOOOW AF
ATTFEhOWL DBE AFDFIACESOM DFROi111E CALMS SKIED
OmededgagedSince DecedLaetssenaes
115. SIGNATURE AND TITLE OF CERTWIER
F
PARVEZ MEMON M;D'.'
116. LICENSE NUMBER
A66640
117. DATE mMdt!/ccyy
07/1'8/2011
(4)� mMdd/c(.yy ::(B) mM m/dd/oeyy.
0 7/13/2011 :07/14/2011
1114 TYPE ATTENDING PHYSICIAN'S NAME. WULING ADDRESS, ZIP CODE
PARVEZMEMONM.D...
3551 Q STREET, BAKERSFIELD, CA 93301
H
K
119.10EFMFyl51471N OPMCNDEATH CCOffEDATTIENCUR CATEMD PLACE SW® R10M71ECsUSES00g5
MANNER OF DEATH Natural Aaidap Homicide Suicide hR7 Ca1W sea m
ImsBetlgdlicn determined
120. INJURED AT WORK?
YES lNJ( NO
171. INJURY DATE mm/dd/0053
122, HOUR R4 Hours)
123. PLACE OF INJURY(e.g., home, construction s18, wooded area, ate.)
124. DESCRIBE HOW INJURY resulted (Events which rulted u injury)
125.1.0CA010N OF INJURY (Street add number, or location, and city, and zip)
126. SIGNATURE OF CORONER /DEPUTY CORONER
127. DATE m0dd!ccyy
128. TYPE NAME, TITLE OF: CORONER /DEPUTY CORONER
STATE
REGISTRAR
A
r:.
B
I C
D
E
I11gnIN1II111IIIIlUII91II111111118IIIIIIIInIIIIIIIIIIIIIIIIIIIIOIIIII
'010001001829533'
FAX AUTH.0 CENSUS TRACT
J ib CERTIFICATI( VITAL RECORD
l(7
Lu
u
/4,
A
s�
m
PUBLIC HEALTH SERVICES DEPARTMENT
1800 MT. VERNON AVE., BAKERSFIELD, CALIFORNIA 93306 -3302
STATE RLE NUMBER
LI 14513 CASITAS CANYON ROAD
COUNTY of KERN
CERTIFICATE OF DEATH
STALE OFCNIWRNM
USE BLACK INK O N L Y ER OUTS OR ALTERATIONS
VS.11allEV i/06)
O
2
Q
6
t 13. EDUCATION HIOWLe Megree 14/15, WAS DECEDENTHISPANICM TNO(AYSPANISN7 Rlyas,see worksheet onbadd
(saewd on gold
w HS GRADUATE
13 No
3201115002850
LOCAL REGISTRATION NUMBER
1. NAME OF DECEDENT -FIRST (Given) 2. MIDDLE
GERALD I EDWIN
8, BIRTH STATE/FOREIGN COUNTRY
AR
10 SOCIAL SECURITY NUMBER
11. EVER IN US. ARMED FORCES?
YES NO El MK
3.1A3T(F My)
MAY
AKA ALSO KNOWN AS Inalude'1u1 AKA (FIRST, 1015014 UST)
4 DATE OF BIRTH rnm/dd/ccyy
10/26/1933'
12. MARITAL STANS/SRDP' (d Twd Owe)
MARRIED
5. 45E Yre 1 PUNORI ONF WAR
77 Month Days
F IJNOER24 /MIMS
Hours Mown
7. DATE OF DEATH 99Md/eeyy
07/15/2011
6. SEX
M
H0511 .124 Hour)
0330:'
16. DECEDENTS RACE- Up to 3 races may be listed (see worksheet on hack)
CAUCASIAN
O 17. USUAL OCCUPATION Type o wo1K roc detest e1111a. D0 NOT USE RETIRED 18. KIND OF BUSINESS OR INDUSTRY (e.g., grocery stave, road construction. empigment agency, etc.)
CONTRACTOR 1 BUILDING CONSTRUCTION
20. DECEDENTS RESIDENCE (StMat and numbecor location)
19. yEARSI
50
CERTIFIED COPY OF VITAL RECORDS
STATE OF CALIFORNIA ss DATE ISSUED
COUNTY OF KERN
This is a true and exact reproduction of the document officially
registered and placed on file in the office of the VITAL RECORDS
SECTION OF THE DEPARTMENT OF PUBLIC HEALTH SERVICES.
�1t1l 2 2 2011
CLAUDIA JONAH, M.D.
PUBLIC HE TH OFFICER AND LOCAL REGISTRAR
OF BIRTHS AND DEATHS
This copy is not val unless prepared on engraved border displaying seal and signature of registrar
NIKO (KW 06/10
00611
1 VI 7 II J \L WA n V vi
11 II II 1
a FF �2Addisiir 4t I
[t a l l �l ()F
00037` Q �t A O 1//
C'AIA 0
MITA
.uuurl
a ..a �.3• a... e
0