HomeMy WebLinkAbout968921I, Rosie Ann Kennedy, also known as Rose Kennedy, being first
duly sworn under oath do hereby declare as follows:
1. On or about the 16 day of November, 2012, my brother,
Fred John Celebrin, also known as Fred J. Celebrin, died as is
evidenced by the official certificate of death attached hereto and
incorporated herein by this reference.
2. At the time of his death, he owned an interest in real
property as a joint tenant with right of survivorship, said real
property being located in the County of Lincoln, State of Wyoming,
and is more particularly described as follows:
The Lot Numbered Three (3) of Block Numbered Fifty -four (54) in the Second Addition to the Town
of Kemmerer, Lincoln County and State of Wyoming, as surveyed, platted and recorded.
Together with all buildings and improvements thereon or thereunto in anywise appertaining thereto.
3. Said real property was originally conveyed to, Ferdinando
Celebrin and Katie Celebrin, husband and wife, Fred J. Celebrin,
Rena Kathleen Celebrin and Rosie Ann Kennedy, as joint tenants with
right of survivorship by Warranty Deed dated July 19, 1976, and
recorded on July 19, 1976, in the Office of the Lincoln County
Clerk and Ex- Officio Register of Deeds in Book 128PR, Page 544.
4. By reason of my brother's death, his title and interest in
the above mentioned real property has passed to the surviving joint
tenants identified in the above described Warranty Deed.
STATE OF WYOMING
)ss
COUNTY OF LINCOLN
The above and fp egoing instrument was subscribed and sworn to
before me this /7— day of Gle r 2013, by Rosie
Ann Kennedy, also known as Rose Kenned
WITNESS my hand and official seal.
My commission Expires:
■f°I. tS
RECEIVED 1/7/2013 at 4:51 PM
RECEIVING 968921
BOOK:802 PAGE:309
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
Rosie Ann Kennedy, also known
as Rose Kennedy
Nota y Public
April E runslii Notary Public
St,e ct
Wyorni g
scion Expires
0030,9
CERTIFICATI(VITAL RECORD
4, Atte
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Decedent: State File Number:
Name: Fred John Celebrin
Gender: Male Social Security Number:
Date of Birth: March 05, 1934 Age at the Time of Death:
Date and Place of Death:
Date of Death: November 16, 2012 County of Death: Lincoln
City of 'Death: Kemmerer
Location: 'South Lincoln Nursing Center 711 Onyx St,
Additional Decedent Information:
Place of Birth: Kemmerer, Wyoming
Residence: Kemmerer, Wyoming
Marital Status: Never Married
Armed Forces: Yes
Name of Father: Ferdinando Celebrin
Name of Mother: Katerina Carollo
Informant: Rose Kennedy Relationship: Sister
Disposition:
Method of Disposition: Burial
Place of Disposition: Diamondville Cemetery, Diamondville, Wyoming
Funeral Home or Facility:
Facility: Ball Family Chapel, Evanston, Wyoming
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) CAD
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming,
DATE ISSUEDWednesday, December 05,_2012
G This copy i s nqt valid unless prepared on paper with an engraved border.
d afints 5 1
James McBride
Deputy State Registrar`
2012- 003675
78 years
Interval:
Minutes
Other Significant
Conditions:
Manner of Death: Natural Death Time of Death: 18:55 (Actual)
Certifier:
Type: Physician
Name: George C. Krell, fv1.D.
Address: PO Box 390, Kemmerer, Wyoming, 83101
Date Filed: December 04, 2012
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