HomeMy WebLinkAbout967548File No.: 130503
STATE OF WYOMING
COUNTY OF LINCOLN
I, Susan M. Fleischman aka Susan Marie Fleischman, being of lawful age and first duly sworn
according to law, upon my oath, depose and state:
1. That I am of adult age, a resident of Kemmerer, Wyoming, and the Affiant herein.
2. That by virtue of the conveyances which are recorded in the office of the County Clerk for
Lincoln County, Wyoming, located at Kemmerer, Wyoming is recorded a Quit Claim Deed
dated the 20 day of July, 2012, in Book 751PR on page 134 conveys unto Donald Ray
Severns and Susan Marie Fleischman, Husband and Wife, the following described property, to-
wit:
The West Half of the East Half of the Southwest Quarter of Section 12, Township 21 North
Range 117 West of the 6th P.M., Lincoln County, Wyoming.
ALSO
SS.
RECEIVED 10/25/2012 at 1:51 PM
RECEIVING 967548
BOOK: 796 PAGE: 794
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT TERMINATING ESTATE
The Northwest Quarter of the Southwest Quarter of Section 12 of the resurvey of Township 21
North Range 117 West of the 6 P.M., Lincoln County, Wyoming.
LESS AND EXCEPT the land described in Warranty Deed recorded October 13, 2005 in Book
601PR on page 133 of the records of the Lincoln County Clerk.
LESS AND EXCEPT the land described in Contract for Deed recorded May 24, 2010 in Book
747PR on page 636 of the records of the Lincoln County Clerk.
3. That said Donald Ray Severns on the "day of S
y died and
a copy of the original certificate of death, certified to as true and correct by public authority in
which the original of said certificate is a matter of record, is attached hereto as Exhibit "A
00 79
4. That by reason of death of said Donald Ray Severns by reason of 2 -9 -102 W.S. (1980), the
decedents interest and title in said conveyance has terminated and title to the real property
conveyed thereby has vested absolutely in Donald Ray Severns and Susan Marie Fleischman
continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
Octobe 25, 2012
Susan M. Fleischman aka Susan Marie Fleischman
State of Wyoming)
)ss.
County of Lincoln)
The foregoing instrument was subscribed and sworn to me by
:sr/ .e,,t 674s-e4 r�r le. this S of
Q/-2 >4ie, 2012
Witness a fad official syal.
Notary Public
My Commission Expires:
Lori Kalan Notary ublia
County of y r State of
L
Lincoln r Wyoming
My Commission Expires 2/2612015
/fc
0079
Pate and Place of!peath:
Date of Death:
City of Death:
Location:
Additional Decedent
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father`
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Facility:
(a) Metastatic Esophageal Cancer
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
STATE OF WYOMING 00
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
:.Donald Ray :Severns
Male SocialSecurity.Nurnber:
November 15, 1958 Age at the Time of Death:
September 19, 2012 County of Death:
Kemmerer
292' Loma Vista Dr.
Information:
Waldon, Colorado
Kemmerer, Wyoming
Married Susan Marie Fleischman
No
Richard Ray Severns
Gail Ann Olson
Susan Marie Fleischman
Cremation
UFD Cremation Center, South Jordan, Utah
Ball Family Chapel, EVanston, Wyoming
Physician
George C. Krell; M.D.
PO,: Box 390, Kemmerer, Wyoming; 8310:1
October 12, 2012
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming,
DATE ISSUEDMontlay, October 15, 2012.
This copy is not valid unless prepared on paper with an engraved border.
Relationship:
The immediate`; cause is listed on the first line. followed by anyundertying causes
Natural Death Time of Death:
James McBride
Deputy State Registrar
2012- 003066
53 years
Lincoln
20:47 (Actual)
'V.
CERTIFICATION OF VITAL RECORD
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