HomeMy WebLinkAbout968622RECEIVED 12/21/2012 at 10:00 AM
RECEIVING 968622
BOOK: 801 PAGE: 160
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING
SS.
COUNTY OF LINCOLN
I, JOAN MARIE DILLON, being duly sworn under oath, state as follows:
1. That Winthrop G. Dale had joint tenancy with rights of survivorship with me in
land in Lincoln County, Wyoming, more particularly described in the Quitclaim Deed that was
recorded in the Lincoln County, Wyoming land records in Book 567 PR at Page 467 on
September 17, 2004 as Instrument No. 902900. Attached hereto is a copy of that Quitclaim
Deed.
2. That Winthrop G. Dale died on October 23, 2012. Attached hereto is an original
copy of the Certificate of Death issued for Winthrop G. Dale.
3. That pursuant to Wyoming Statutes 2 -9 -102, I certify that the joint tenancy of
Winthrop G. Dale has been terminated by his death and that title to the above referenced land is
now in the name of Joan Marie Dillon, a single woman.
DATED this 7th day of November, 2012.
ACKNOWLEDGED, SUBSCRIBED AND SWORN TO before me on this 7th day of
November, 2012 by JOAN MARIE DILLON.
WITNESS my hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of State of
Lincoln I<..+,m Wyoming
My Commission Expires: July 16, 2015
AFFIDAVIT OF SURVIVORSHIP
My Commission expires: tri I(
4 (7/At l i .at(i 4W6
AN MARIE DILLON
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RECEIVED
67> LINCOLN COUNTY CLERK
t QUITCLAIM DEED
902 00 C:!F5 AM 10 :110
JOAN MARIE DILLON, Grantor of Thayne, Countyp inc9Jln ate of Wyoming, for and
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in consideration of TEN DOLLARS ($10.00) and other valuable corgis} efaticn, it1'.6 paid, receipt of which is
hereby acknowledged, CONVEYS AND QUITCLAIMS to JOAN M JE bILLON `and WINTHROP G.
DALE, as joint tenants with rights of survivorship, grantees of County of Lincoln, State of Wyoming, the
following described real estate situate in County of Lincoln and State of Wyoming, hereby releasing and
waiving all rights under and by virtue of the homestead exemption laws of the State, to -wit:
Lot 71 of the Star Valley Ranch Plat 6, Lincoln County, Wyoming as
described on the official plat thereof.
SUBJECT, however, to all reservations, restrictions, protective covenants,
exceptions, easements and right -of -way of record, in sight, or in use.
WITNESS my hand this 1 day of September, 2004.
STATE OF WYOMING
SS,
COUNTY OF LINCOLN
The foregoing instrument was acknowledged before me by JOAN MARIE DILLON this 1 day
of September, 2004.
WITNESS my hand and official seal.
CHRISTINA K. ALLRED NOTARY PUBLIC
County of State of
Lincoln x;;+ Wyoming
My Commission Expires 4/30/2005
My Commission Expires: Li `OS
NOTARY PUBLIC
N MARIE DILLON
v Zv3
Decedent:
Name:
Gender:
Date of Birth:
Place of Birth:
Residence:'
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Other Significant
Conditions
Manner bf Death:
Certifier:
Type:
Name:'_
Address:
Date Filed:
du3._�L�1�(�.�_� lam!•
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent Information
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Facility:
Winthrop Garrard Dale
Male
June 16, 1925
Moscow, Idaho
Star Valley Ranch, Wyoming
Divorced
Yes
Harrison Dale
Beulah Garrard
Joan Marie Dillon
Schwab Mortuary, Afton, Wyoming
Hobo spider bite in July of 2012
Natural Death
This copy is not valid unless prepared on paper with an engraved border.
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUED Wednesday, November 14, 2012
State File Number:
October 23, 2012_;
Afton
Star Valley Medical Center 110 Hospital Lane
Cremation
Schwab Mortuary Crematory, Afton, Wyoming
Social Security Number:
Age at the Time of Death:
Relationship:
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) Respiratory failure
(b) Pneumonia
(c) Inactivity,
Physician
Kitchner P. Head, M.D.
110 Hospital Lane, PO Box 579, Afton, Wyoming, 83110
November 13, 2012
Lincoln
Executor
Interval:
James McBride
Deputy State Registrar
2012- 003401
518 -20 -5877
87 years
AnneMc BaukNote. Co
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CERTIFICATION OF VITAL RECORD s
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