HomeMy WebLinkAbout969420AFFIDAVIT OF SURVIVORSHIP
WYOMING STATUTES 2 -9 -102
U U
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Julia G. Sarvey, being first duly sworn upon her oath, deposes and says as follows: M
1. She is the surviving spouse of James Edward Sarvey, who came to his death on or about
the 6th day of December, 2012. w
2. James Edward Sarvey was married to your affiant at the time of his death.
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3. Immediately prior to the death of James Edward Sarvey, the decedent and Julia G. Sarvey
the affiant herein, had interests in the following described real property, which interests were
held as husband and wife:
A. N2 of Lot 29: Lot 30: Block 36; Higgins Addition to the Town of Glenrock, Converse
County, Wyoming.
A/K/A 602 South Third Street, Glenrock, Wyoming 82637
Ownership and title to the above described interest in real property is evidenced by a Quitclaim
Deed from James E. Sarvey, Julia G. Sarvey, and Sally Sarvey Downs, grantors, to James E.
Sarvey and Julia G. Sarvey, husband and wife, grantees, which instrument was recorded April 9,
2010, and may be found in Book 1367 of Deeds at Page 881 as Instrument 972070 in the office
of the County Clerk of Converse County, Wyoming.
B. N1 /2W1/3 of Lot 4 and N1 /2 of Lot 3, all in Block 6 in the Town of Grover, County
of Lincoln, State of Wyoming
Ownership and title to the above described interest in real property is evidenced by a
Quitclaim Deed from Sally Sarvey Downs, grantor, to James E. Sarvey and Julia G. Sarvey,
husband and wife, grantees, which instrument was recorded April 12, 2010, and may be found in
Book 745 of Deeds at Page 331 as Instrument 952854 in theoffice of the County Clerk of
Lincoln County, Wyoming.
a
Ownership and title to the above described interest in real property is evidenced by a
Quitclaim Deed from Sally Sarvey Downs, grantor, to James E. Sarvey and Julia G. Sarvey,
husband and wife, grantees, which instrument was recorded April 12, 2010, and may be found in
2010 -1714 in the office of the County Clerk of Albany County, Wyoming.
4. Your affiant hereby certifies that the said James Edward Sarvey, who came to his death on
or about the 6th day of December, 2012, as evidenced by a certified copy of his Certificate of
Death attached hereto, is the same James Edward Sarvey who is named in the document
mentioned above and whose death terminated his estate in said property.
5. By reason of the death of James Edward Sarvey, all interests in the above described
property became vested solely and exclusively in his surviving wife, your affiant herein, Julia G.
Sarvey.
DATED this 7th day of February, 2013.
STATE OF WYOMING
ss.
COUNTY OF CONVERSE
The aforesaid Affidavit of Survivorship was subscribed and sworn to before me this 7th
day of February, 2013, by Julia G. Sarvey.
QUENTIN RICHARD NOTARY PUBLIC
County of State of
Converse Wyoming
Commission Expires March 7, 2015
My Commission Expires:
C. Town 23 North, Range 71 West, 6th P.M.
Section 1: Lot 2, SW4NE4, 80.01 acres; Albany County, Wyoming
Witness my hand and official seal.
Notary Public
D''ecede'nti State File`Number
Name. Jdmes.Edward.Sarvey,.
r Socials ecurit Number
Gender ,:Y; Male g•�: Y
Date of Birth: July 06:,1941'' Age 'at the Tirrie,of Death:
Datehd Place of•'Datii:t
Date of•Deeth: December 00' 2012
City of Death: :Casper-
L Wyoming Medical Cen
a Additional Decedent InformatIOf:
P)ace of Birth Caliper; Wyoming
Residence:; •Glenrock .W omin U
Y 9. fY
Marital Status: Married`; Julia Gardrer,
Armed Forces No 9
Name'of Father lEdward'Otis
Informant JuliaSarvey P.eleti`
Name of Mother 1ar aret.W att
Y
onship:f,- 'N
r �Disposition
Meit1OVIof Disposition 'Burial
Placeof Disposition ti Glenrock Cemetery a
f i is
ITAL RECORD
'Funeral Home.or Facility:
"Facility
;Cause'of Death:
The immediate cause is fisted orithe'first line followed by nny,underlying causes: Interval."
(a);Hyperkalemia 1>Week
(b),.ChronicRen d FailureN 1 Week
`1` We
(c).Metabolic Acniosis
Otfi'erSignificant::
Conditions:
Mar"- ner°of,Death
Certifier:
i•.
DateFi
na'
EPARTMENT OF
`CERTIF,ICATE OF? EAT
H''
CetItityf cf Death`
er1233East2nd ;Street
Bustards'Funeral Home'Crorper.Wyomifg
Physlaanf.
Robert G;Da, MD
1-6500 E. 2nd (Suite 200) Casper Wyoming?'82609
December 26,'2012:
TI 1 a'true' certification, of the `docurr ent n file‘in the office Vital
Shit s Seivlces Cheyenne, Wyoming
;;DATE ISSUED`W D ecember 26,:2012
Ih r rcJ 1 w`uith, aneengrnved border
mss Ma
James McBride'
Deputy'State'Registrar
20.12=003953
71 yeas
Natrona'
F
Am!'ll nnlinui N s Ony""q
'y ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE
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