HomeMy WebLinkAbout968296STATE OF P J'Do
COUNTY OF '(1 0{.\
RECEIVED 12/3/2012 at 3:30 PM
RECEIVING 968296
BOOK: 799 PAGE: 625
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT
ss.
0062 a U
i d t e
#�G
orn
SINCE f904
I, CLARA M. BEADERSTADT upon being duly sworn and upon oath do say and depose as
follows:
That I am a citizen of the United States of America over the age of 21 years, and a resident of
LINCOLN COUNTY, State of WYOMING.
That I was well and personally acquainted with DUANE E. BEADERSTADT, in that certain
Deed dated OCTOBER 29 1999, recorded in LINCOLN COUNTY, at Page 073, BOOK 438
RECEIVING NUMBER 862501 in the office of the Recorder of Lincoln County, Wyoming.
That I know of my own knowledge that DUANE E. BEADERSTADT in the said deed and
DUANE ELWIN BEADERSTADT, mentioned in the attached Certified Copy of Certificate of
Death was one and the same person.
This Affidavit is intended to terminate the TEANANTS BY THE ENTIRETIES of DUANE E.
BEADERSTADT also known as DUANE ELWIN BEADERSTADT in the following described
property:
Lot 20, PRATER CANYON ESTATES UNIT NO. 4, Lincoln County, Wyoming, according to the
official plat thereof.
Executed this as day of 1\\110e-f, pl a
Land Title Company File Number: 63671
Affidavit Terminate Joint Tenancy Page 1 of 2
STATE OF 0 f.30 (1
COUNTY OFav\
On, before me, the undersigned, a Notary Public, in and for said State, personally appeared,
CLARA M. BEADERSTATDT known to me, and/or identified to me on the basis of satisfactory
evidence, to be the person(s) whose names) is /are subscribed to the within instrument and
acknowledged to me that he /she/they executed the same.
WITNESS MY HAND AND OFFICIAL SEAL. My commission expires
Notary P blic:
Land Title Company File Number: 63671
Affidavit Terminate Joint Tenancy Page 2 of 2
ss.
1
G- S
OFFICIAL SEAL
CRYSTALANNE OLSEN
NOTARY PUBLIC OREGON
COMMISSION NO. 454573
MY COMMISSION EXPIRES DECEMBER IS, 2014
Decedent:
Name:
Gender:
Date of Birth:
Date andPlace of Death
Date/of Death: October 66, 2009
City of Death: Star Valley Ranch
Location:
Additional Decedent
Flace•of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Certifier:
Type:
Name:
Address:
Date Filed:
Other Significant:
:Conditions:
State File Number:
Duane Elwin Beaderstadt
Male Social Security Number:
January 11, 1926 Age at the Time of Death:
81::cheyerinev,prele
Information 1
Goodman, Kansas
Star Vslley Ranch Wyoming:
m
Married Clara Maetta
Informant: Blaine Beaderstadt
Disposition:
Method of Disposition: Burial
,Place of Disposition: Thayne.Cemetery Thayne Nyoming
Funeral Home or Facility:
Facility:
Cause of; Death:
The imm6d cause fs fisted on the first foll owed by any underlying'causes
(a) Arteriosclerotic Cardiovascelar,Disease
Schwab Mortuary Afton,'Wyommg
Natural Death:;
DEPARTMENT OF HEALTH
CERTIFICATE 9F DEATH
Coroner
Michael Richins, Coroner
274 N St,.Box 57; "Grover, Wyoming, 83122
October 14, 2009
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne Wyoming,
DATE ISSUED: Thtirsday,`May 19, 2011 o putyStaie R Breeden
This copy is not unless. prepared on paper with an engrayed border
Re�ations
2009- 002905
83 years
Lincoln
nterval:
CERTIFICATION OF VITAL RECORD