HomeMy WebLinkAbout967191STATE OF DVk L
AFFIDAVIT OF HOLDER OF
COUNTY OF ��it �\.0( LIFE ESTATE INTEREST
LEIGH H. PERKINS, being first duly sworn, deposes and says as follows:
1. That Leigh H. Perkins and Romi Perkins are joint holders of a life estate
interest in the properties located in Lincoln County, Wyoming and more particularly described
on Exhibit A attached hereto and made a part hereof (the "Properties
2. That Romi Perkins died on February 13, 2012, at Lake Buena Vista,
Florida and said death certificate has been issued, a copy of which is hereby presented as Exhibit
B.
3. That by virtue of the death of Romi Perkins, her life estate interest in the
Properties has terminated and this fact should be reflected on the land and tax records of the
Lincoln County, Wyoming.
SWORN TO BEFORE ME and subscribed in my presence this day of
045622, 000001, 601210819.3, Perkins Affidavit re: WY Life Estates 6 -1 -12
RECEIVED 10/4/2012 at 10:29 AM
RECEIVING 967191
BOOK: 795 PAGE 453
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
o.y9siv\r\J
Leigh H. Per ns
1
004 5 3
CONSUELO RAPHAEL
Notary Public, State of Ohio
My Commission Expires
May 10, 2014
EXHIBIT A
Properties
1. "Hale" 167.32 acres in Lincoln County, WY
Warranty Deed dated 10/2/87 and recorded in Book 359PR, Page 698.
2. "Porter" 76.3 acres in Lincoln County, WY
Warranty Deed dated 2/11/88 and recorded in Book 474PR, Page 292.
3. "Roberts, Brisco Brenda" 61 acres in Lincoln County, WY
Warranty Deed dated 7/1/01 and recorded in Book 470PR, Page 295.
4. "Roberts, Robert Martha" 60 acres in Lincoln County, WY
Warranty Deed dated 11/15/88 and recorded in Book 267PR, Page 315
5. "Linford, Edward" 37 acres In Lincoln County, WY
Warranty Deed dated 12/27/88 and recorded in Book 269PR, Page 340.
6. "Stoddard" 40 acres in Lincoln County, WY
Warranty Deed dated 8/10/93 and recorded in Book 344PR, Page 149.
7. "Stoddard" —16.18 acres in Lincoln County, WY
Warranty Deed dated 10/12/93 and recorded in Book 341 PR, Page 2.
8. "Stoddard- Long" 78.05 acres in Lincoln County, WY
Warranty Deed dated 12/13/94 and recorded in Book 362PR, Page 264.
9. "Taylor" 269 acres in Lincoln County, WY
Warranty Deed dated 11/24/97 and recorded in Book 405PR, Book 248.
10. "Wernick" 18.2 acres in Lincoln County, WY
Warranty Deed dated 5/18/00 in Book 446PR, Page 95.
11. "Linford, Scott" —160 acres in Lincoln County, WY (6/21/01)
Warranty Deed dated 6/21/01 and recorded in Book 467PR, Page 83.
2
0045'
0045
12. "Turley" Lincoln County, WY
Quitclaim Deed dated 5/25/00 in Book 446, Page 416.
13. Any other real property in Lincoln County, Wyoming in which Romi Perkins had a life
estate interest.
3
EXHIBIT B
Death Certificate
4
0 4
I°ECE0� SHAME IAdlEUlryp
ka s"' Perkins
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p?emate;.
3. DATE OF BIRTH (Mont, Day. Yse4 4a.AGE.LealeMMay 4b UNDER I Y
(Yeas) Months
Ma 1929. 81
Y. fi
Dap
4c, UNOFR/ AY
Noes Ain 1ss
i
5. DATE OF DEATH (Abnt, OAP Ya44
Eebruary 13, 2,12
.879 0 G ALSECURlTY 91ktece,' 7.91RTHPWTCE paymekstmemm og..cenby)
Mir'
Cleveland, Ohio
IaCUm1 or DEATI •I.
Orangerg
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220. RELATIONSHIP TO DECEDENT 33e. INFORMANTS MAILING STATE
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290. IF CREMATION, DONATION OR BURIAL AT SEA.
WAS MEDICAL EXAMINER
APPRO.YkORAN11E0*. _NP
NAME OP NERA4E ETTY 1 tDov�+e�Fu nera7. Hine,
274 LICENSE NUMBER (01 Licensee)
42107
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UNOSNLYINC CAUSE
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43. DATE OF),NJIJRY (Mat: Day; rea)
496. CAW OR'TOWN
50'0ESCRIEEHOW DLURv'OCCVRIIED
91971
OFFICE of VITAL STATISTICS
CERATIFI €D CO`'RY
FLORIDA OERTIF[CATE OF- A F
Inc.
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43e. IF SURGERY MENTIONSITIN PART I OR II, EN7.11 REASONFOR SURGERY
45 :IF FEMALE WAS SHE PREGNANT WITHIN TNEPAST YEAR::
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214 (SI9na0r dTIa d7c.o9leH 2111. DATESIGNEO(nin1Mlyyy) j'J2TIMEOF DEATH (24N.) xi MEDICAL EXAMINERSCA0E NUMBER
P 31e i#TUAg, 02/14/2012. 0812 1 a 0 s; a 0 1 a.
24iU 9E:NUMO M r)'/ 351. CERTIFIER• NAME 95'NMAE OF ATIENGINGPHYSIGAN,(/•0Aer Wen CeiINS1`
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THIS DOCUMENT IS PRIMED OR PHOTOCOPIED ON SECUR, ••pp Y[ PAP WITH OFWTHE G 0
IN 7 SEAL OF THE STATE OF FLORIDA. DO NOT ACCEPT WITHOUS THETA 0s SENCE)EF THE W9TERAB
THE DOCUMENT FACE CONTAINS 'A MULTI- COLORED BACKG ND„ Hb GEBtl� EMBOSSED 5 C. THE B
CONTAINS'SPECIAL LINES WITH TEXT AND SEALS IN THERMOCHFiOMId NF
"condo AS SUCH
29d72JP CODE
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25■ CERTRERB STATE Me rCRYOR TOWN ]Ba STREET' ADDRESS
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=WEN In dead
IB E4IPCODE,
32806
me. WERE AUTOPSY RNGINGS'AVMUBLE
TO COMPLETE THE CAUSE OF DEATH?
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41.010 TOBACCO USE CONTRIBUTE 7,0 DEATH?
Yes' LNe .x...
470. DATE OFSURGERY (M;, WY,. Yr•1
42a. WAS AN AUTOPSY
PERFORMED
_Yes L. No
Vdn43 days rtEyaer el deifh•p
47.11ME.09INJURY (24117,)
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