HomeMy WebLinkAbout968958Kathleen Needham, being first duly sworn, states as follows:
1. Affiant is the surviving spouse of Waldo R. Needham and therefore has an
interest in the real estate which is the subject matter of this affidavit.
2. Affiant states that Waldo R. Needham died at Cheyenne, Laramie County,
Wyoming, on the 10 day of December 2012; the facts of said death more fully appear from the
Certificate of Death, duly certified by the State Registrar of Vital Statistics, attached hereto and
incorporated herein by this reference.
3. Said Decedent and Kathleen Needham, husband and wife, acquired certain real
property, by Warranty Deed, dated May 24, 1993 and recorded in the records of the County
Clerk of Lincoln County, Wyoming in Book 329PR at Page 329, Reception No. 765354, which
property is more particularly described as follows:
Lot 34, Forest Meadow Subdivision, according to the official plat thereof
recorded in the Office of the County Clerk, Lincoln County, Wyoming.
4. This Affidavit is filed for the purpose of establishing the fact of the death of said
Waldo R. Needham, a tenant by the entirety in the above described property, and to make an
official record of the termination of the interest of said Decedent in and to said property,
pursuant to the provisions of W.S. §2 -9 -102.
Dated this 27 day of December 2012.
STATE OF WYOMING
COUNTY OF LARAMIE
Acknowledged, subscribed and sworn to before me by Kathleen Needham on this 27
day of December, 2012.
HOWARD V. SCOTLA III NOTARY PUBLIC
COUNTY OF
LARAMIE
STATE OF
�'�isaan* WYOMING
MY COMMISSION EXPIRES APR. 6. 2016
AFFIDAVIT OF SURVIVORSHIP
ss.
f ealag4'.1/. j16 'thleen Needham
My Commission Expires: 4/ L
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RECEIVED 1/9/2013 at 11:07 AM
RECEIVING 968958
BOOK: 802 PAGE: 415
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ANN
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent information
Other Significant.
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
671531
Diabetes mellitus
Natural Death
This copy is not valid unless prepared on paper with an engraved border.
t,a
CERTIFI CAT I 1 VITAL RECORD
Waldo Raymond Needham.
Male
x 1936
Newark, New Jersey
Cheyenne, Wyoming
Married Kathleen Milling
Yes
John Needham
Aimee Raymond
Garry Needham
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Social Security Number:
Age at the Time of Death:
December 10, 2012
Cheyenne
Cheyenne \Regional Medical Center 214 E 23rd Street
County of Death:
Place of Birth:
Residence:
Marital Status:
Aimed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
of Disposition:
Funeral Home or Facility:
Facility:
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes:
(a) Cardiac arrest
(b) Anemia
(c) Chronic renal failure
Relationship:
Cremation
Wyoming Cremation Service Cheyenne, Cheyenne, Wyoming
Schrader Funeral Home, Cheyenne, Wyoming
Physician
John H. Babson, MD
1331 Prairie Avenue, #1, Cheyenne, Wyorhing, 82009
December 18, 2012
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATEISSUEDThursday, December 20, 2012
Time of Death:
2012- 003860
1429
76 years
Laramie
James McBride
Deputy State Registrar
16:32 (Actual)