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IKtUtiVING 969864
BOOK: 806 PAGE: 464
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
In the Matter of the Estate of:
BRENDA A. SMITH,
Deceased.
STATE OF WYOMING
County of Teton
ss
I, Paul D. Smith, being first duly sworn, do hereby state as follows:
1) I am an adult, competent to testify, and make the following affirmations based
upon my own best investigation, information and beliefs;
2) I am an interested person and make this Affidavit pursuant to WS 2 -9 -102;
3) This affidavit relates to the following described parcel of real property situate in
the County of Lincoln, and State of Wyoming, more particularly described as
follows, and hereinafter referred to as the "Subject Property
See attached Exhibit A.
Also known by street and number as: 94 Appaloosa Trail, Etna, WY 83118
Together with and including all improvements thereon and all appurtenances and
hereditaments thereunto belonging. Subject to all covenants, conditions,
restrictions, easements, reservations, rights and rights -of -way of sight and /or
record.
4) The Subject Property was conveyed to Paul D. Smith and Brenda A. Smith,
husband and wife, as tenants by the entireties Grantees, from George Todd
Smith and Abbey L. Smith, husband and wife, Grantors, via that certain Warranty
Deed recorded in the Office of the Lincoln County Clerk, Lincoln County,
Wyoming, as document number 926041, in Book 646 of Page 184 on or about
January 12, 2007;
5) That Brenda A. Smith died on February 5, 2013, and the place of last residence of
Brenda A. Smith was the County of Teton, State of Wyoming. See Attached
Death Certificate;
6) Decedent, Brenda A. Smith, was the same party who was named in and whose
death terminated her previous estate in the property under the aforementioned
Warranty Deed, and following the death of Brenda A. Smith, Paul D. Smith is the
sole interest holder in the Subject Property.
FURTHER AFFIANT SAYETH NAUGHT.
Dated this 12 day of February, 2013.
STATE OF WYOMING
County Of Teton
Scott D. Weav
County of
Teton
My Commissio
The foregoing Affidavit of Survivorship Pursuant to W.S. 2 -9 -102, was subscribed, sworn to
and acknowledged before me by Paul D. Smith, Affiant, on this 12 day of February, 2013.
Witness my hand and official seal.
Sci
AFFIDAVIT OF SURVIVORSHIP
Page 1 of 1
AFFIDAVIT OF SURVIVORSHIP
PURSUANT TO W.S. 2 -9 -102
Paul D. Smith
Notary Public for the State of biAi 1
My Commission Expires: 41 Jl a b 1 3
00464
IB I T j
DESCRIPTION FOR
GEORGE TODD SMITH AND ABBEY L. SMITH
SOUTH TRACT
To -wit:
000185
That part of the NE' ',4NE1/4 of Section 34, T36N R119W, Lincoln County, Wyoming, being part of
that tract of record in the Office of the Clerk of Lincoln County in Book 606 of Photostatic Records
on page 497, described as follows:
BEGINNING at the southeast point of that tract of record in said Office in Book 606 of
Photostatic Records on page 497, N55 26' -15 "W, 58.70 feet, of the southeast corner of said
NEV4NE'/;
thence N89°-38'-41"W, 1283.50 feet, along the south line of said tract, to a point on the west line
of said NE%4NE' /4;
thence N00 18' -49 "E, 556.01 feet, along said west line, to a point;
thence N89 48' -22 "E, 838.99 feet, to a point;
thence N00 11' -38 "W, 75.00 feet, to a spike;
thence N89 48' -22 "E, 442.29 feet, to a spike on the westerly right -of -way line of U.S. Highway
89;
thence S00 02' -34 "W, 116.95 feet, along said right -of -way line, to a marker at Station 1968 +00
50' LT;
thence S00 03' -19 "W, 496.35 feet, along said right -of -way line, to the POINT OF
BEGINNING;
ENCOMPASSING an area of 17.31 acres, more or less;
the ASE BEARING for this survey is the east line of the NE'/ of Section 34, T36N R119W,
beirig S00 07' -18 "W;
SUBJECT to and TOGETHER with a right of ingress and egress and utilities over, under and
across a strip of land sixty (60) feet in width, with the centerline described as follows:
BE INNING at the northeast spike of the above described SOUTH TRACT;
the ce S89 48' -22 "W, 442.29 feet, to a spike;
the northerly and southerly right -of -way lines of the above described easement to be shortened or
len ened as necessary to intersect the east line of said tract to create a continuous easement with
a minimum width of sixty (60) feet;
each "point" marked by a 5/8" x 24" steel reinforcing rod with a 2" aluminum cap inscribed,
"SU tVEYOR SCHERBEL LTD AFTON WY PLS 3889 with appropriate details;
each "spike" marked by a 3/8" x 12" steel spike referenced by a 5/8" x 24" steel reinforcing rod
with 2" aluminum cap inscribed, "SURVEYOR SCHERBEL LTD AFTON WY PLS 3889 with
appropriate details;
each "marker" marked by a 6" x 6" concrete post with brass cap inscribed: "STATE HIGHWAY
DEPT. R.O.W. MARKER with appropriate details;
all in accordance with the plat prepared to be filed in the Office of the Clerk of Lincoln County
titled, "GEORGE TODD SMITH AND ABBEY L. SMITH PLAT OF FAMILY EXEMPT
TRACTS WITHIN NE'/NE% SECTION 34 T36N R1I9W, LINCOLN COUNTY, WYOMING,
dated 15 November 2006, as revised.
16 December 2006
0046
9`.
11 �l u
i IIIIJ
ICI
I
DECEDENTINFO R
Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:`
trldastry /Business:
Residence:
Mother's; Name:
Facility or Addrss:
SAY
DISPOSITION INFORMATION
Method of Disposition: Crerntion
Place
Date of 1Drsposition February 20 1 3
Utah 84132
Date Registered: 5, 2013_
Date Issued: F=ebruary 5 2013
MATION
February 5 2013
Salt Lake City
64
Neon, Kentucky
No
Paul Smith
Shipping and Packaging
Jackson, Wyoming
Sarah Hall Gibson
Huntsman Cancer Institute
CERTIFICATE OF DEATH
State File Number: 2013001763
Brenda `S Smith
MEDICAL CERTIFJC ON
Medical Professional Chakrav
arthy B Redd)r MD, U of U Hospita
Time of Death:
County of Death:
Date-of Birth:
Sex:
Marital_Status_
Usual Occupation:
Education:
Fathers Name:
Facility Type:
INFORMANT INFORMATION
Name: Address:- Paul PMB Sm 84 ith Jackson�W yom,.� Relationhip:
Mailin 2,
9 ing83002
ace of Disposi Lake Ntlts Utah,
FUNERAL HOME, INFORMATIO
F une r al Home: cpeser Memorial Mortuary
Address: X36 East 71)0 South 'Salt Lake City Utah`$41
Funeral Director: a %MarjorieC Smiths
08:03
Salt Lake
December`29, 448
Female
Married
Owner
Associate Degree
Jonny Ray Adams
Hospital Inpatient
Spouse
ortff 19b01East 701'- 1111introbe
CAUSE OF DEATH
Respiratory failure
Due to (or a consequ`ce of): Adult RespiratoryaDistress Syndrome
Dueto (or as a Con of): Pneumocystis Jiroveci Pneu moms=
e. to (or as a consequence of): Multiple Myeloma
M
Tgb Du acop �LJse Non user
;ediaal Examiner Contactedt, es Autopsy Performed. No Manner of Death-','N t al 1
Salt Lake City;
11141110V
CERTIFICATI
VITAL RECORD
\auu u g 11
4 0 1
Thiele an exact reproduction of the document registered in the State Office of_Vital Statistics.
Seo features of this official documen include Intaglio Border,Y& R images Into!) c ycloids_
ultra violet fibers and hologram image of the Utah State Seal, over the words "Stale of-Utah". This
document displays the date, seal and signature of the State Registrar and the. County/District Health Officer.
P t+��d
Irk
0 4a ae Janice L Houston, StateRegistrar
;tke a� b Officesof V ital Statistics
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as 3724 89 7 Gar Edwards
Director /Health ficer
County/Distnct HealthZepartmen
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