HomeMy WebLinkAbout969515Affidavit of Survivorship
I, Sharon Adams, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date of June 12, 2007, for valuable consideration, Geoffrey Imlay and
Deborah Imlay, husband and wife, by deed of that date, which deed was duly filed of record in the
Office of the Lincoln County Clerk, on June 15, 2007, in Book 662, Page 282, conveyed to Ronald
D. Adams and Sharon Adams, husband and wife, the following described land, in the County of
Lincoln, State of Wyoming, to -wit:
Lot 97 of Star Valley Ranch RV Park Plat 1, Lincoln County, Wyoming as described on the official
plat filed January 5, 1983 as instrument No. 588522 of the records of the Lincoln County Clerk
That by reason of said conveyance aforesaid, the said Ronald D. Adams and Sharon
Adams, husband and wife, became the owners of said real property, and the title thereto vested in
them continuously from the date of said conveyance, to the date of death of Ronald D. Adams,
also known as Ronald Dean Adams, on the 15th day of May, 2012. That by reason of and upon the
death of Ronald D. Adams, also known as Ronald Dean Adams, title in the above described real
property had vested in Sharon Adams.
Affiant avers and certifies Ronald D. Adams, also known as Ronald Dean Adams, is the
identical party named with Sharon Adams in the aforementioned deed, whose death terminated
his interest, title and estate in said real property; and Affiant attaches hereto, and makes a part of
this affidavit, a copy of the Official Certificate of Death of said decedent, duly certified by the
public authority in which said death certificate is a matter of record.
Dated this day of 2013.
State of 1\I CA/ 4 A—
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County of C A t�
CYNTHIA LUBER
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My Commission Expires: 1' 1 7-
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Sharon Adams
Subscribed and sworn to before me, a notary public in and for said County and State, by
Sharon Adams, this day of rc5brk..eL 2013.
WITNESS my hand and official seal.
007 23
RECEIVED 2/15/2013 at 12:03 PM
RECEIVING 969515
BOOK: 804 PAGE: 723
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
CERTIFICATI VITAL RECORD 4
wis R. Garre
rector/Health leer
County /District Health Department
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im
DECEDENT INFORMATION
Date of Death: May 15, 2012
City of Death: Clearfield
Age: 65
Place of Birth Ogden, Utah
Armed Services: Yes
Spouse's Name: Sharon Richardson
Industry/Business: Unknown
Residence: Mesquite, r levada
Mother's Name: Marjorie Boatright
INFORMANT INFORMATION
Name: Sharon Adams
Mailing Address: 196 Sage Way, Mesquite, Nevada 8
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: IMlyers Crematory, Ogden, Utah
Date of Disposition: May,18,2012
FUNERAL HOME INFORRMATION
Funeral Home: Myers Mprtuary ,L`aa;
Address: 250 North Fairfield
Funeral Director: Kent D Christiansei
MEDICAL CERTIFICATION
Medical Professions, Jeffery L DeGrauw
CAUSE OF DEATH
RESPIRATORY FAIJRE,
Due to (or as a consequence of) :SMALL CELL LUNG CAN
Tobacco Use: Underling Cause „,y'
Medical Examiner Contcted: Yes Autopsy °Performed: No
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Facility or Address: 1195 Valhalla Drive, Cleafield, Utah
Date issued: May 17, 201
This is an exact reproduction of the document registered in_the State Office of_ Vita[ Statistics.
Security features of this official document include: intaglio Border, V R images in top; cycloids,
ultra violet fibers and hologram image, of the Utah State Seal, over the words "State of Utah". This
document displays the date. seal and signature of the State Registrar and the County/District Health Officer.
morn we _Al 4t Win w 1
Janice L. Houston, State Registrar
Office of Vital Statistics
CERTIFICATE OF DEATH
State File Number: 2012005993
Ronald Dean Adams
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual .Occupation
Education:
Father's Name:
Facility Type:
015
Relationship:
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Dean Richard Adams
Son's Home
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