HomeMy WebLinkAbout971486Hic
Land7i Co
SINCE 1904
I, MARK ALAN CADY, being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America over the age of 21 years, and a
resident of ALASKA
That I was well and personally acquainted with ELLEN MARGUERITE CADY in that
certain Warranty Deed dated SEPTEMBER 14, 1998 and recorded in Book 417, at Page 268
as Filing No.853245 in the office of the Recorder of LINCOLN County, Wyoming
That I know of my own knowledge that ELLEN MARGUERITE CADY in the said deed
and mentioned in the attached Certified Copy of Certificate of Death was one and the same
person.
This affidavit is intended to terminate the JOINT TENANCY of ELLEN
MARGUERITE CADY in the following described property:
LEGAL DESCRIPTION
Lot #8, Riverview Ranchettes Subdivision according to that plat filed in the Office of the
Lincoln County Clerk, Lincoln County, Wyoming
Subject to all covenants, restrictions, easement rights and rights -of -way of sight and or of
record.
EXCEPTING THEREFROM all oil, gas or other mineral rights.
Tax Roll No. 3419- 253 -02- 008.00
AFFIDAVIT
Dated this 3)dayof ,(A, 2013 A.D.
RECEIVED 6/14/2013 at 2:53 PM
RECEIVING 971486
BOOK: 813 PAGE: 718
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
a/4,k_ g
MARK ALAN CADY
00718
LH
STATE OF Wyoming)
SS
County of Lincoln
On the day of A.D. 2013 personally appeared before me
the signer(s) MARK ALAN CADY of the within instrument, who duly acknowledged to me that
he /she /they executed the same.
Commission expires: fACU ZO(
Residing in: Li s c, 4
USA HATCHER NOTARY PUBLIC
County of State of
Lincoln Wyoming
My Commission Expires: 6 March 2017
INDIVIDUAL ACKNOWLEDGMENT
Notary Public
00719
LH
b6
LOCAL FILE NUMBER'
11 EVER IN U,S.
ARMED FORCES?
DNES '�N0
128,'STREETANO NOIMBCR
1 DECEDENTS LED/11- NAME (Include AKAa 4 any) (Fuld.
ELLEN MARGUERITE CADY
4 SOCIAL SECURITY
IF DEATH OCCURRED INA HOSPITAL' IF OEATN OCCURRED SOMEWNEREOTREF ),TIUNANOSPI1:"1-4 I••, 1,
Inpoll t 0 OoIR l en). L:1 DOA D H p0.o Faddy D N Nosy /,Long T OMe F 01674 y.. 0 acedenlY Hum 016 (Spotlly)
70 FACILITY 5016756 ,nol inllulon gwe 1 I d ba) Y 1' "#k tg1 7o�GT,YITOWN OR LOCATIONO DEATH 1 7tl ICOUNTYOF OEATN;
1:34
2,6,6 FIDLER b 11HA'NE LINCOLN-
W a. BIRTHPLACE (5114 008 1 10 or !omen ouo ie) 1 (A AR(T A l75 T ATU5 ATTI�JE D /T d Sr1RNN1NG $PAUSE (11 wd gN pdor Io H 1 M rwpal.
MTTON, PA x koo o �I d G012DON VLRGIL,.CADY
I Q New IMrMO x. ..Y
'Screw:menuy 001 pondel na gy
loading 1 100 cause 110108'00 enel
Enter the UNDERLYING CAUSEt,
(Ormo e° oriryury that,inglelanIhe
,ayenta 10081'0101110 4671 LAST Iw-
30 DATE OF IleJURY (A10lDay/Yr)
370.. DATE CERTIFIED .(Mo/Day/Yr),
266 FTDLER
PATHEWS NAME (Fu 1 67)841 Lail)
THORVAL' D P LYTZER
16. METHOD 011 OISQOSITIONf li
0D bill 0 Don bn
'�`'t[C melon E0lallb1,
lee SIGNATLRE KUNFR E ICE LICENSEE
182101 r p
P883')) EnI Iho eignNlcenl ♦:pnGl
211 WEREAUTOPSV FINDINGS AVAILABLI
0 YES I 7 N0
20. IF FEMALBAGED 10;51
L1,N 1 prowiani within pa0)Year
0 Nagnont 0116000180 10
0 o'1,19,1,p5egn,spl,601pra wllhln 42 days 01 80010:.
Se AGE Lealabadey,
75
L..9
011,10000711010 Wyprnn
v D 0160,
ttO
RELATIoNsuIP TO DEC
STATE OF. WYOMING
,DEPARTMENT OF HEALTH
CERTIFICATE OF! DEATHr'
Ob UNDER 1 YEAR
or, a
INCOLN'
This is a true and exact reproduction of the document on file in the office of Vital'
Records Services, Cheyenne, Wyoming:'
DATE ISSUED: JAN 2:8' 2005..
20 ACTUAI)IORU+R SUMEO T e0 DEATry 412 D AT ORO( B EAD (MOlOOp/Y )4
3 :17 Q.:M,a f d 'DECEMBER 4,22,;1 2004:
1 e u It CAUSE OF
PART I Ent Ihoe, cNl'o 1 tl Ip
s 1 Wlos complkali0n Iha1 800tH? calmod the ammo 00 NOTienla 1 rm(
arrest 00011 1 ry 0 1 va(rh 0180llbr 1101 on w l I 1h. Ibb DO NOTA EnI o 0
tl: xa fi n
14 MO A THEITS.M �t',
ARIOR TOFP MARRIAGE,I L.Hj' ly
RYN
SO D ST F'x}IS
,ARiJP
f 150 MAIL{NG AODR (5408 nd0UrMe7 C ly 51 I. 25 Obdel l k1g fi
BO,CC1'83 WY 834122 1 4
tii PUCEOF 01SP0SIT i(Narra,„ YI k2 )7b.,t.00ATION G Q W Nft {D STA1
aemelwyor loryl MMk A li Y{ r Iml,•q
'EA EAGLE ROOKCREMATORY IDAHO^ FaA'LLS, ID>
tg I O FAC r, tl I I ;,Y..x 1{ T H Y )9b ADDRESS OF FAI
S,CHWAB' MQRT A TON, WYi. 8311.0
'UNDER 1. DAY
ED' DEAD'.
3 DATE OF OEATH,(MPIDay/Yr)4apoe 6700116)
DECEMBER` +22, 2004,
B DA EOF BIRTN (MoNey/Y) 1.1
AUGUST w4,; 1929
34 LOCATION OF INJURY (010111 end number, City or Town: Slel0) 35'..IF TRANSPORTATION ACCIDENT; SPECIFY
.:0 DIN0,10201.100 0 P08001r8n
1 10 thee.(SPeellYL.
30 DESCRIBE HOW )NJURY'OCCURREO, AND IF TRANSPORTATION INJURY,THE•TVPEIS) OF VENICLEIS)IINVOLVED (AUtano0lb pkkup, dwbroydl, AN O14ysI, eb
STATE FILE:, NUMBER
App aaknala larval
On e d 0U
OA
J ",,DID TOBACCO USE CON T BIB U TE.00
a� DEATH?
'J'J YES 0 55) 0PROB ABLY� I�UNKNOWN'
38, NEB OFOEATH
(1 ul Not pregnant prognanl 43 d y b 1 y er Oebrs Eee10 N 1 I, Hanlcl
A000 t '0 panning mveellgollon
37` PLAOE,0, INJURY1P. 'honw 00nset,.50611 sic)
3701 CERTIFIER (Check only one)
,,R,NYSICIAN —To 11, hp l °Orly knowl dg d0 gl c oned anhe gore, dam ndplec0 or ggp w pppddd d 1 III 00o0o)e) aodpwnner GANG Allen t), Carlor
CORONER bo
(M lho aw 01 e0emin 1100 a d 104810201611 b my op bn 80011, occu I the firm', lene,anp,plece, due w bo cabee(s) and manner b (0Sp(Ial'L r ll.0: Sex 280
.Afton, W,Y 83110
PRL 307 8855852 Fax` 885 -5847
7
386 0600811011515090 RE016TRAR,(MOl0ex/Yrj;
25,3NASAN'AUTOPSY
PERF,OR(.1E07,"
O,YES NO
37. NAME :Y(7LE AND ADDRESS OF CERTIFIER. (Typo or 9.501), r
ALLEN D..,CARTER;,MD..110 HOSPITAL "'LANE' "AFTON,';WYOMING4
tics te a,.•. r
—'11 1722 115 P*
-w;.‘ d;l,r :1111'•
:ib \i 1;11:. '4.
CERTIFICATION OF VITAL RECORD
a
s ZrA
Luoinda Mc
Deputy State'Registrar
11 This copy Is not valid unless prepared on, paper with an, engraved, border, displaying the date, seal_ and slgnaturc;of the Deputy State Registrar
013
,i}