HomeMy WebLinkAbout969817STATE OF WYOMING
ss.
COUNTY OF LINCOLN
AFFIDAVIT OF SURVIVORSHIP
I, TAMMIE S. O'NEIL, Affiant, being of lawful age and first duly sworn, upon my oath
depose and state as follows:
1. I am an adult residing in Lincoln County, Wyoming.
2. This affidavit is made pursuant to W.S. 2 -9 -102.
3. By virtue of a Quit Claim Deed executed by Allen L. O'Neil on September 30
2005, and recorded in the records of the Lincoln County Clerk at the Lincoln County
Courthouse in Kemmerer, Wyoming, on October 3 2005, in Book 600, Page 155,
Receiving Number 912440, I am a tenant by the entireties with Allen L. O'Neil in the
following described real property located in Kemmerer, Lincoln County, Wyoming, to wit:
Lot 12 of Block 21 of First Addition to the Town of Kemmerer, Lincoln
County, Wyoming as described on the official plat thereof.
4. Allen L. O'Neil died on December 2 "d 2012, and a certified copy of the original
death certificate on file in the office of Vital Records Services in Cheyenne, Wyoming, is
attached hereto as Exhibit "A
5. By reason of the death of Allen L. O'Neil his interest and title as a tenant by the
entireties under said Quit Claim Deed is terminated and title to said property has vested
absolutely in Tammie S. O'Neil continuously since the death of Allen L. O'Neil.
FURTHER AFFIANT SAYETH NOT.
DATED this t day of
The foregoing instrument was subscribed and swo n to me by TAMMIE S. O'NEIL,
personally known to me, this day of /r/gi�c% 2013.
Witness m hand and official seal.
SCOTT SARGENT- NOTARY PUBLIC
COUNTY OF
LINCOLN
STATE OF
WYOMING
My Commission Expires 7 ?Ne
Tammie S. O'Neil
inla A c
/L.
My Commission expires: 7 /q 20/
364
RECEIVED 3/7/2013 at 9:02 AM
RECEIVING 969817
BOOK: 806 PAGE: 364
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
2013.
Exhibit "A"
tiUdb
Name:.; Allen Lee Oneii
ender:', Male Social ?Security Number:;
Date of,Birth August 09,'1956 Age :.atthe;Time.of�Death`. :56 years
Date?and `Place.: of• Death:.:
Date: of Death: December •02' 2012` Y
Count of Death: Lincoln
Cityof Death: Kemmerer�a'' x}x
Location: 40 Ruby<Stre
Additional Decedent Informa ion
t
Pla e of.Birth: Midland, Texas
Residence: Kemm Wyoming
Marital'' Status: Married• Tammie S: Hobbs'
'Armed'Forces: Jo
'`Name'of Father: OlenyCecil Oneil
Name'of M other: Wanda JoyceiBrown
;In'formant Tammie'
isposition
ethod of•Disposition a SRem oval from State
Ip°
ce ti Jal:Cemetery•; TX
'of Dis p o
Funeral Home or Facility
Facility Bail Familly`Chapel Evanston Wyoming
ecedent `State'File':Number: 20 1'2= 003781
Cause `otDeath
The "immediate cau
(a),Myocardlal dlifarction
:;Other Significant
Conditions:::;
Certifier:
?ype
Name:;
Address::„.
Date-
Filed:
CERTIE6CAT @ON Cf RECORD
4 t,: W`��.. ern Y� t� t`�:
:DEPARTMENT V OF ?HEAL'TH N
:x'
CERTIFICA;TE:bF DEATR'
This is'a• true certification of the document on.film in the office ..of
StatisticsiServices Cheyenne
ATE ISSUED Thursday January _03, 2013`
t
copy.!is not valid unlesslpreporad on•ruper engrnved border,
Coroner
`.Cliff: Boyd,Depuhr...
274N'St; '..Box 57, Grover; Wyoming;' 83.122::..
December 12;',2012:.
;an`;>the 'first line followed;by any underlying causes.
W,Ife'
amss /r /�6yje[�
James McBdde
Deputy State-Registrar'
tt x CERTIFICATE'
m t t �v°Yih� t9��f ,d.l��.'tLSt:�� ANY ALTERATION OR ERASURE VOIDS THIS
Libovi •ayt'YY+L� =9,:tll`. 4, 97. G`' r!}Ssr „�al\.{k+lt '!:.�'.',�l:�F 1, >IviiidCe`h�.`