HomeMy WebLinkAbout971457RECEIVED 6/13/2013 at 12:55 PM
S
RECEIVING 971457
STATE OF WYOMING
SS. BOOK: 813 PAGE: 602
COUNTY OF LINCOLN JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT TERMINATING ESTATE
I, �JQ, S ltA ii. I, being of lawful age and first duly sworn
according to law, upon my oath, depose and state:
1. That I am of adult age, a resident of L -cif/ c0
and the Affiant herein.
2. That by virtue of the conveyances which are recorded in the office of the
County Clerk for Lincoln County, Wyomin located at Kemmerer,
Wyoming is recorded a Warranty Deed Quit Claim Dee dated the
day of SC),J\ \Cl 5 in Book c 49 PR on
page conveys unto
the following described property, to -wit:
c \0 3
L. L
3. That said kA S Lo\ S An CCcs l4 'On the 3 day of
/U C Cy a O I died and a copy of the original certificate 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 Qn (q iL )L Lby reason
of 2 -9 -102 W.S. (1980), the decedents interest and title in said conveyance
has terminated and title to the real property conveyed thereby has vested
absolutely in
continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
Dated 1 2 l
State of Wyoming
County of Lincoln
The foregoing instrument was subscribed and swore} to me by
g G_ xo, this I a day of C 2013
Witness my hand and official seal.
My Commission Expires:
C-c,1L
C(} e:. 1 -ems
Notary Public
5 "40300 X 9 -15 -2015
GLORIA K. BYERS NOTARY PUBLIC
County of
Lincoln
State of
Wyoming
My Cornmisson Expires September 15, 2015
692422
CERTIFICATION OF VITAL RECORD'
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Decedent: State File Number:
Name: Douglas K McCaskill
Gender: Male 'Social Secuiity Number:
Date of Birth: December 03, 1942 Age at the Time of Death:
Date and Place of Death:
Date of Death: March 31, 2013 County of Death:
City of Death: Afton
Location: Star Valley Medical Center 110 Hospital Lane
Additional Decedent Information:
Place of Birth: Idaho Falls, Idaho
Residenc6: Afton, Wyoming
Marital Status: Married Dawn Stadtmueller
Armed Forces: No
Name of Father: Kale McCaskill
Name of Mother: Dorothy Holden
Informant: Dawn McCaskill Relationship: Wife
Disposition:
Method of Disposition: Cremation
Place of Disposition: Schwab Mortuary Crematory, Afton, Wyoming
Funeral Home or Facility:
Facility: Schwab Mortuary, Afton, Wyoming
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) COPD
Certifier:
Type: Physician
Name: Allen D. Carter, M.D.
Address: 110 Hospital Lane, PO: Box 579, Afton, Wyoming, 83110
Date Filed: April 04, 2013
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUEduesday, April 09, 2013
This copy is not valid unless prepared ompaper with an engraved border.
2013- 000991
70 years
Lincoln
Interval:
Other Significant
Conditions:
Manner of Death: Natural Death Time of Death: 03:55 (Actual)
Amol4cainBantN,
amce• Irna: c.
J ames McBride
Deputy State Registrar
0-
qua soT�sc otiimt�sn; �.mcsawnvAa*
:My commission expires:
QUITCLAIM DEED
$4.00
1 c:�rea Aufl 16.:.1985
D0c* 22PR AT 9A
I No. 64 1, 3 vft:.
STAR VALLEY INDEPENDENT, INC., a Wyoming Corporation,
GRANTOR, of Afton, Lincoln County, State of Wyoming, for and
in consideration of Ten ($10.00) Dollars and other valuable
considerations in band paid, receipt whereof is hereby
acknowledged, CONVEY AND QUITCLAIM TO:
DOUGLAS K.
McCAS[ILL and DAWN S. McCASZILL, Husband and Wife, as
Tenants by the Entireties, GRANTEES, of Afton, Lincoln
county, Wyoming, the following described real estate,
situate in Lincoln County and State of Wyoming hereb
releasing and waiving all rights under and by virtue of the
homestead exemption laws of the State, to -wit:
BBGIJJIIn at a point 5 rods East of the Northwest
Corner of Lot 1, Block 20, in the Town of Afton,
Lincoln County, Wyoming and running thence South
10 rods; thence East 5 rode; thence North 10
rods; thence West
5 rods to the Point of Begin
MISS my hand this 7K day of
r186.�.
Secretary
STATE OF WYOMING
COUNTY OF rr n 88.
On this ,5L day of
personally appeared •LRA j�v X98r, before me
to me personally known, who, by me duly sworn, 'did
say that be%,r►e• is the President of WAR V ALLY
II., and that the seal affixed to a instrument the pT.
corporate seal of said corporation, and that said instrument
was signed and sealed on behalf of said corpora o
authority of its Board of Directors and said
acged aid
instrument to be the free act and deed of knowle corpo
Witadea"my hand and offici seal.
,1
NTOARY PUBLIC
0004
EXHIBIT B