HomeMy WebLinkAbout971912Affidavit of Survivorship
1, Dawna Farrell, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date of June 22, 2007, for valuable consideration, Strebel Living Trust,
dated 11/25/75, amended 4/18/98, Robert P. Strebel and Robert P. Strebel, Jr., trustees, by deed
of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on July
2, 2007, in Book 664, Page 351, conveyed to David H. Farrell and Dawna Farrell, husband and
wife as tenants by the entireties, the following described land, in the County of Lincoln, State of
Wyoming, to -wit:
Lot 53 of Star Valley Ranch RV Park Plat One, as platted and recorded in the official records of
Lincoln County Wyoming
That under the date of July 21, 2003, for valuable consideration, Glen E. Goggins and
Norma S. Goggins, by deed of that date, which deed was duly filed of record in the Office of the
Lincoln County Clerk, on July 22, 2003 in Book 527PR, Page 788, conveyed to David H. Farrell
and Dawna Farrell, the following described land, in the County of Lincoln, State of Wyoming, to-
wit:
Lot 54 of Star Valley Ranch RV Park Plat 1
That by reason of said conveyances aforesaid, the said David H. Farrell and Dawna Farrell
became the owners of said real property, and the title thereto vested in them continuously from
the date of said conveyance, to the date of death of David H. Farrell, also known as David Homer
Farrell, on the 16th day of November, 2011. That by reason of and upon the death of David H.
Farrell, also known as David Homer Farrell title in the above described real property vested in
Dawna Farrell.
Affiant avers and certifies David H. Farrell, also known as David Homer Farrell, is the
identical party named with Dawna Farrell in the aforementioned deed, whose death terminated
his interest, title and estate in said real property; and Affiant attaches hereto, and makes a part of
this affidavit, a copy of the Official Certificate of Death of said decedent, duly certified by the
public authority in which said death certificate is a matter of record.
Dated th day of 2013.
re State of
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r (7; Z w w Subscribed and sworn to b fore me, a notary public in and for said County and State, by
Y Dawna Farrell, this _5__ day of 201 3.
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WITNESS my hand and official seal.
Dawna Farrell
Notary Public
JANET BODE NOTARY PUBLIC
County of State of
Lincoln Wyoming
Wyoming
My Commission Expires: July 28, 15
0312
CERTIFICATI
ITAL RECORD 4,
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DECEDENT INFORMATION
Date of Death: November 16, 2011
City of Death: St George
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry /Business:
Residence:
Mother's Name:
Facility or Address:
INFORMANT INFORMATION,
Name: Dawna Farrell Relationship: Wife
Mailing Address: 924 South Bloomington- Drive, StGeorge, Utah 84790
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: Metcalf Mortuary, St George, Utah
Date of Disposition: November 22, 2011
FUNERAL HOME INFORMATION
Funeral Home: Metcalf Mortuary.,
Address: 288 West St George Blvd, St George, Utah 84770
Funeral Director: Dan R Ernstrom
MEDICAL CERTIFICATION
Medical Professional: Grace J Paradela MD, 1449 North 1400 West, #19, St George, Utah 84770
CAUSE OF DEATH
Cardiac Arrhythmia [onset: 5 Months]
Due to (or as a consequence of): Atrial Fibrillation [Onset: 5 Months]
Tobacco Use: Did notContribute
Medical Examiner Contacted: Yes Autopsy Performed: No Manner of Death: Natural
Date Issued: December 21, 2011
85
Salt Lake City, Utah
Yes
Dawna Williams
Entrepreneur
St George, Utah
Pearl Boughton
924 South Bloomington Drive
AMENDMENT HISTORY
12/21/2011 Decedent Date of Death from 11 /15/2011 to 11/16/2011
This is an exact reproduction of the document registered in_ the <State Office of Vital Statistics:
Security features of this official document include: Intagltb Border, V R images in top cycloids,
ultra violet fibers and hologram image of the Utah State Seal,-over the words "State of Utah This
document displays the date, seal and signature of the State. Registrar and the County/District Health Officer.
■0:
%se p "na 0 Janice L. Houston, State Registrar
,0 Office of Vital Statist
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CERTIFICATE OF DEATH
State File Number: 2011013757
David Homer Farrell
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Time of Death:
County of Death:
Date of`Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
16:00
Washington
May 1, 1926
Male
Married
Businessman
High School or GED
James Farrell
Home
David W. Blodgett
Director /Health Officer.
County /District Health Department
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