HomeMy WebLinkAbout968922I, Rosie Ann Kennedy, also known as Rose Kennedy, being first
duly sworn under oath do hereby declare as follows:
1. On or about the 24th day of September, 1986, my father,
Ferdinando 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 fathers'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
AFFIDAVIT OF SURVIVORSHIP
WITNESS my hand and official seal.
My coomm s ion Expires:
0031'
Rosie Ann Kennedy also kno4Ain as
Rose Kennedy
The above and p egoing instr twas subscribed and sworn to
before me this day of J 7 P 1 JL t.4-r 2013, by Rosie
Ann Kennedy also known as Rose Kennedy.
G /JI
Not Public
COT,
RECEIVED 1/7/2013 at 4:53 PM tin ti
RECEIVING 968922
t Cori ,ion Cxnires
BOOK: 802 PAGE: 311
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
�61
FOR REC -I p. 1NNa, Bade, AnwnL'An OAdNORITEBCEWI HYary NYlTan,
AGE -lAtl BAldae
INSTNIICTIDNC ATMa Mr.1fA M.5 Gamma.RMARIme EeOlM,.0 ERTEI.l (Yee
e RE e. White p°h' Italian 5 93
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RACE OF DEATH-.d. r MIN hINAb.Nemealeof C ae NOS?. DRIEST. Maces RDA.
r WAreipuhp( and e, •uAerl OREM RA.IMNAR MAMbe
PARENTS
Trestles
CERTIFIER
COUNTY OF DEATH
T,, So':. Lincoln Hospita Inpatient TO. Kemmerer TA t a i lwn i n
STATEOFBIRTN ffrrot LSRAY/ T: Cm 1OF# NEVER DAVID COUNTRY VARRIEEU. NEVER INIED. SURVIVINGaEOUSE riftege,/Amnide. A.A.) WAS BECEDFNTEVFR W U S.
me.rmp Y MINED FORCES?
Spat, Yet erNo,
e Italy e. U.S.A. m. Married Katerina C Tolle Nn
SOCIAL SECIIATY NUMBER USUAL OCdiATION(Gim ad Ned deme enAE moo o/ NW OFBUaNESSOi INDUSTRY
,a. Dairy Farmer ,a.: Dairy
CRY, TOWS on TION STREET MO NUWEfT
REBEENCE$TATE
is Dominic
67.3127
NFOfMANT- NAME(Type orPn+,0
u. Rose Kennedy
,e Lincoln
ATHER -NAME FIRST MIDDLE
BURIAL, CREMATION. REMOVAL, DATE CYO.b.. Yr.1
OTHER(R ..if/
is Burial la. 9127/86
R►E MACE UCENSEEO Pram AMEg MAASER
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DATE &0(ED CFDEATH
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RARE OFATTERUSNG ►Bi CLAN IF OTNER THAN CISRIFER !'1}y.rF.lw•
2,e.
NAMEAND ADOt MRS OF CERTIFER(PHYSICUR on CORONEAA(rrpear ►nn,
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P A R T OTHER SIU IFIiNATOONOOQNS- O WAWA eajLMl9 EdbaH but rol MOW M mum pnenw PARru
INJURY AT WOIN (Sri, Yo
DATE OF INJURY afo.,Day, Y,
2q,
This is a (rue certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming,
DATE ISSUED: DEC 2'7 2012
SSL
This copy is not. valid. unless prepared on paper with an engraved border.
STATE OF WYOMING
DAEMON OE HEALTH •IAMEDICAL' SERVICES
CERTIFICATE OF DEATH
::Mal
CITY, TORN OR LOCAf5NOF DEATH
e.. Kemmerer +ed.. 510 Opal
Celebrin
MAILING ADORESS SIREET,OR RE 0 NO
,M. 513 Lignite
CEMETERY ORCREWTORY -NAME
REGISTRAR
248. (8,dmWre, 1111. 0■NOO
Th. NAAECWTE QA
CAUSES (ENTRROVLYO/EUSEPERLMEHMf4, RNA *Won
ANT len AGVT 12Cr
CU
E TO. OR AS A CONSEQUENCE OF:
y .:1 K, CQ 6rSri'I 4-1 (r Fi iw2c
CUE TO. OR AU A CCNSECIRENCE OF:
NOUR OP INJURY.
r g$ 221E
I PRONOUNCED DEAD MMO. AU: VA)
MAN
:'hFtEtf�R� I 1.0,r0 23 'IC:
MOTHER-MAIDEN NAME
RA?CRRNEHON INJURY OCCURRED
Rosa
CITY OR TOWN
Kemmerer
ASV
66
STATE FILE NUMBER
DATE OFDEATH/fde.CAY, Yr,
3, Sept. 24, ;:1986
GATE OF BERN /Moe Er
e.May 26, 1893
MIRRLE
221. AR d.... AM e Mr Mb Addns•eVOMPlon d.ANI OGenedal
dw Oa NM dweBRA.IN .a.
'kb Isinwii dratull.
8 DATE SEINED fi DAL VA/
DATE RECEIVED BY REGISTRAR ML. DAY, VA.I
STREET OR R.F D. Na. OTYOR TOWN
fi9 nn,
7�a�C. da4,1-6. 5
ames McBride
Deputy State Registrar
SOUR OF DEATH
n.. AT
STATE DIP
Wyo. 83101
LOCATION CITY OR TORN STATE
TYD. Diamondvi Cemetery, TM, Diamondville, Wyo.'.
NAREOFFACIUTY *UNDER ADURESBOFFACIITiy
,,Crandall Funeral Home roe Kemmerer, Wyoming
RgNOUNCEDDEAD Maur,
1 NEAR Baum. ARAN TM de W,
3c, k,sw.u
Inwood bMm.n mMl AM death
mwrYAl beEmenmMl led AAA
WAD CASE REFERRED TO CORONER
(Spedfr Y.t brNal
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a{
CERTIFICATI
'rsr_ J1f/ 'a W4,F
7311{1T 17^ yL 1 i
VITAL RECORD