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Home My WebLink About967770Hickman j tNeCo SINCE 1904 AFFIDAVIT I, CRISTE L. MOSS, being first duly sworn on oath, depose and say: RECEIVED 11/5/2012 at 2:17 PM RECEIVING 967770 BOOK: 797 PAGE: 503 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY That I am a citizen of the United States of America over the age of 21 years, and a resident of UTAH That I was well and personally acquainted with BRUCE N. MOSS in that certain Warranty Deed dated JANUARY 15, 1988 and recorded SEPTEMBER 1, 2000 in Book 451, at Page 429, as Filing No. 868030, in the office of the Recorder of LINCOLN County, Utah. LEGAL DESCRIPTION SEE ATTACHED EXFIIBIT A Tax Roll No. 12- 3619- 22 -2 -00- 005.00 Dated this V day of c v-- 2012 A.D. That I know of my own knowledge that BRUCE N. MOSS in the said deed and BRUCE NELSON MOSS mentioned in the attached Certified Copy of Certificate of Death was one and the same person. 0 Q5©n This affidavit is intended to terminate the TENANTS BY THE ENTIRETIES of said BRUCE N. MOSS in the following described property: STE L. MOSS STATE OF UTAH r SS County of (de4') On the gg°I"-` day of October A.D. 2012 personally appeared before me Crts1 L. rY1055 the signer(s) of the within instrument, who duly acknowledged to me that he /she /they executed the same. Commission expires: C Residing in: y Pu lic INDIVIDUAL ACKNOWLEDGMENT NOTARY PUBLIC JENNY GORING 611681 COMMISSION EXPIRES AUGUST 14, 2016 STATE OF UTAH 00504 LEGAL DESCRIPTION Exhibit A 00`5 0 A portion, of the SE1 /4NW1 /4 of Section 22, T36N, R11.9W, 6 Principal. Meridian, Lincoln County, Wyoming, being more particularly described as follows: BEIGINNING at an Iron Pipe set near a Corner fence post in the curved Westerly Right -of way line of Highway U.S. 89 concave to the East and having a radius of 1959.859 feet, said pipe being located S55 °44;59: W 3550.649 feet from the Northeast corner of said Section. 22; thence running Southerly, along said curved Right-of Way line, through a central angle of 5 °23'02" an are distance of 184.161 feet to the P.C. of said curve at the Highway Station 2079 +83, the bearing of the Southerly tangent being N24° 10'39 "W; thence S24 °10'39 "E, 45.465 feet to a point near the Easterly end of a fence from the west; thence S89 °47';34 ":W, 807.35 feet; thence N1 °22'45 "W, 204.35 feet; thence N86 °49'47 "E, 134.23 feet; thence S1 °39'23 "E, 79.99 feet; thence N86 °08'07 "E, 98.90 feet; thence N2 °51' 10 "W, 60.51 feet; thence N88 "02'55 "E, 494.49 feet to the point of Beginning. Together with and including all improvements thereon and all appurtenances and hereditaments thereunto belonging. Subject to all covenants, conditions, restrictions, easements, reservations, encumbrances, rights and rights-of-way of sight andlor record. CERTIFICATION OF VITAL RECORD f v ...a:1 \vvti.i. s... nn, v v ,W v vWWv',..vi ...i.,,,WN, t,, ....s,. Manner of, Death: Natural 0.South Garland, Utah 84312 ait r ri DECEDENT INFORMATION Date of Death: August 15, 2011 City of Death: Elwood Age: 62 Place of Birth: Clearfield, Utah' Armed Services: Yes Spouse's Name: Criste Lee Hill Industry/Business: Aerospace Residence: Elwood, Utah. Mother's Name: Myrtle Wright Facility or Address: 98600 North 5200 West INFORMANT INFORMATION Name: Criste Lee Moss Relationship: Mailing Address: 98600 North 5200 West, Elwood, Utah.84337:`' DISPOSITION INFORMATION Method of Disposition: Burial Place of Disposition: Elwood Cemetery, Elwood, Utah Date of Disposition: August 19, 2011 FUNERAL HOME Funeral Home: Address: Funeral Director: MEDICAL CERTIFICATION Medical Professional: Jan -E Schow, Bear River Medical Arts, 3,00 W CAUSE OF DEATH lung cancer [Onset: 2 Years] Tobacco Use: Unknown;.if User Medical Examiner Contacted: Unknown Autopsy-Performed: No Date Issued: August 18, 2011 AMENDMENT HISTORY 08/18/2011 Birth City from Ogden to Clearfield 08/18/2011 Birth County from Weber to Davis eirp JO we MLA AP .1 We I CERTIFICATE OF DEATH State File Number: 2011.009849 Bruce Nelson Moss INFORMATION Rudd Funeral Home 1234 South Main, Garland, Utah 8431 Gary Joe Rudd Time of Death: County of Death: Date of Birth: Sex: Marital Status: Usual Occupation: Education: Father's .Name: Facility Type: 2 08:00 (Found) fox Elder February 10, 1949 Male Married Engineer Associate Degree Neal Marion Moss Home This is an exact reproduction of the document registered in the State Office of Vital Statistics. Security features of this official document include: Intaglio Border, V R images in top cycloids, ultra violet fii?ers and hologram image of the Utah State Seal, over the words "State of Utah This document displays the date, seal and signature of the State Registrar and the County /District Health Officer. 00 B� I NN Lloyd Berentzen H� Director/Health Officer �l ,b8rt/i/Ofit, County/District Health Department