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HomeMy WebLinkAbout970867Alliance Title Escrow P.O. Box 1367 Kemmerer. WY 83101 File No.: 185271 STATE OF WYOMING SS. AFFIDAVIT TERMINATING ESTATE COUNTY OF LINCOLN being of lawful age and first duly sworn according to law, upon my oath, depose and sate: 1. That I am of adult age, a resident of p and the Affiant herein. 2. That by virtue of the conveyances which are recorded in the office of the County Clerk for Lincoln County, Wyoming, located at Kemmerer, Wyoming is recorded a Warranty Deed dated the day of in Book `4,‘J PR on page conveys unto 4 p,V� `�F5 the following described property, to -wit: 3. That said v \\pp i ce Q\ died and a copy of the original certifibate on the day of of death, certified to as true and correct by public authority in which the original of said certificate is a matter of record, is attached hereto as Exhibit "A 4. That by reason of death of said \4��t w\ ntS by reason of 2 -9 -102 W.S. (1980), the decedents interest and title in�aid conveya ce has terminated and title to the real property conveyed thereby has vested absolutely in \xa�. continuously since the death of the said decedent. FURTHER AFFIANT SAYETH NOT. Date�j State of Wyoming) )ss. County of Lincoln) The foregoing instrument was subscribed fitness my hand and official seal. Notary Public My Commission Expires: LISA M. 3PAULDING NOTARY PUBLIC County of ;tato of Lincoln t Wyoming My Commis:ion EX.pirc.iuly 1B, 2015 and sworn to me by this day of 00102 r z n 0 r 0 0 C L z z n z m m b 7 G) z m m 30 m D G) !T. 0 tp O Co CO V m m m v 1 N 0 w v v Decedent: Name: Gender: Date of Birth: Date and. Place of Death: Date of Death: City of Death: Location: Additional Decedent Information: Place of Birth: Residence: Marital Status: Armed Forces: Name of Father: Name of Mother: Informant: Disposition: Method of Disposition: Place 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) Liver Failure (b) Metastatic Disease (c) Carcinoid Tumors ,Other Significant Conditions: Manner of Death: Certifier: Type: Name: Address: Date Filed: 618088 CERTIFICATI VITAL RECORD Karyn. Walker Hoopes Female October 27, 1948 February 21, 2011 Afton 190 East 4th Ave. Boise. Idaho Afton, Wyoming Married\ William Lloyd Hoopes No Wendell Holmes Walker Be>h Packard William Lloyd Hoopes Burial Afton Cemetery, Afton, Wyoming Schwab Mortuary, Afton, Wyoming Natural Death DEPARTMENT OF HEALTH CERTIFICATE OF DEATH State File Number: This is a true certification of the document on file in the office of Vital Statistics Services, Cheyenne, Wyoming, i 4 DATE •ISSUEDTuesday, March 20, 2012 This copy is not valid unless reared on paper with. an engraved border. Jf PY prepared PP lP. Social Security Number: Age at the Time of Death: County of Death: Relationship: Physician Kitchner P. Head, M.D. 110 Hospital Lane, PO Box 579, Afton, Wyoming, 83110 February 24, 2011 2011 000475 62 years Lincoln Husband Interval: four weeks July 2010 July 2010 07:13 (Actual) d i anneS James McBride Deputy State Registrar 185271 EXHIBIT "A" Part of Lot 1 of Block 21 of the Town of Afton, Lincoln County, Wyoming being more particularly described as follows: Beginning at the Northeast corner of said Lot 1 and running thence West 10 rods; Thence South 111/2 rods; Thence East 10 rods; Thence North 111/2 rods to the place of beginning. uO1O