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Home My WebLink About972167Name of Child Date of Birth Address Living /Dead Date of Death By Which Spouse A Ltx i viDRi9e.thDk.EY «1 02la ?Caf4Pi (aia)1 no k1v1A;C. JO z8-I t �E $'q,J 1.01 Op 1 s Pv ,GA-. RECEIVED BOOK: LINCOLN 7/23/2013 at 2:13 PM RECEIVING 972167 816 PAGE: 324 JEANNE WAGNER COUNTY CLERK, KEMMERER, WY Name of Spouse Date of Marriage Living /Dead Divorced Date`�of�Defath orWa Divorce settlement? If "'Y,es, attach copy 1jARS'oR 5-31-917 /r Na JO z8-I /JD STATE OF 1Z 14.L1 Po R.1 /9' COUNTY OF„,4N ktieS D0.15P0 r J SKNirJr L. fr yEi 3 s� T hat affiant was personally and well acquainted with the above named decedent during the lett for A 6 years. A Decedent died t 5 1: on or about the day of 0 4_10br R. 20,2_, being 5i» ,Is C.AL /.t! RA) /A- at the time of death That the following statements and answers to the following questions are based upon the personal knowledge of affiant and are true and corrcct. 1. Did decedent leave a will? 145 If so, has the will been admitted to probate A Give name of County and State in which such proceedings are pending, and name and address of executor. (If decedent left a wlll;, please attach:, a 'certified ,copyl`of same,''toget'her with a copy of .the ,order of court`admltting.;it to ,probate letters testamentary.) 2. If decedent left no will, have administration proceedings been started? /r/4 If so, give the name of the county and state in which said administration proceedings are pending and name and address of administrator 3. Have ancillary probate proceedings been had on decedent's estate? If so, when? AJ Where? 4. If no administration proceedings have been started, are there any plans to have the estate administered? 5. Did decedent leave any unpaid taxes, including federal estate or state inheritance taxes or other debts? give as nearly as possible, the amount of such taxes or other debts, to whom owing, and whether they have since been paid 6. Was decedent surety on any bond or guarantor of any other person's indebtedness at time of death? details as to principal debtor, amount, etc 7. Were there any suits pending or judgments rendered against decedent at time of death? nature, amount involved and parties 8. Marital Status of Decedent at Time of Death (married, single, divorced, widow, widower) M,42:R 1 1 9. If decedent was ever married, give the following information for each marriage: (List names °i0.order,oft- marriave)• 10. If decedent had any children by any spouse, or adopted any children, give the following Information: I CF a� mucus:' :ndk r 1 rod ko y ax):) rxi* K)2maJ+' r r 05 Ate G-De se 1 f AD.t, a SS. AFFIDAVIT OF HEIRSHIP OF of lawful age, being first duly sworn, on oath deposes and says: CounJy„State of CAZ-1 9L/V /4 R years of age, and a resident of /JO er's lifetime, having known deceased N pl'0 e E5S /up /CJ U If' so, give If so, state briefly the 0324 and If so, Description OwIJ R. r�U3 Date Acquired 6/.00 From Whom? ��11, rr Mor* k.. State How Acquired (Gift, Purchase, Inheritance or Under a a If acquired by Purchase, were funds used those of decedent only or community property funds with spouse? Date of Death a� Wiill ll l Name of deceased child 11. If a deceased child left descendents, give the following information: 12. If decedent left no children or descendents of deceased children, then pleasefu'rnish the follawfrig information a. Give names of parents of decedent: Name Father Mother Address Living /Dead Date of Death b. Give names of brothers and sisters of decedent: Name M.q 1\f4.4. L y A)04-1- Relation Address Living /Dead PALM mkVS NNevApA- L/14 ;4)G Date of Death c. Give names of children of deceased brotheror'sister: Name of Child Child of Date of Birth Address Living /Dead 13. If decedent left no heirs covered by item 12 above, then attach a full and complete affidavit of Heirship of said decedent in narrative form. 1 4 Give locatiort or descrip on of homestead of decedent, as of date of death: J Z7 CE, D o iiL O•• 1 ..")9A) /,g FugisPo, eA 939as 15. As to each tract of land or interest in land owned by the decedent at the time of his death which following information which will be used primarily for the purpose of determining whether property space provided is.,inSufficient, attach exhibit giving information as to each tract). 16. Here briefly state facts and circu (such as being a relative, a close friend, or attorney or agent for, decedent) which will show basis and source of information given above: Ci 0 .5 f Pk/ 1 E. MALACHI ELGUERA Commission 2014557 Notary Public California San Luis Obispo County Pt My Comm. Expires March 24, 2017 1 j n��`� Subscribed and sworn to'before me this d My commission expires: fAtraCt4 1.21 STATE OF COUNTY OF That CAvi t%oQ N l SAN Limt df,i0fO therein are true and correct. M R.n)R/E Lr 6 has Subscribed and sworn to before me this ,eho L was personally and well acqua nted with read the above affidavit by P i 1 T My commission expires: A141 Z 1 I 'ZO (i- sS "SUPPORTING AFFIDAVIT of L� of lawful E. MALACHI ELGUERA Commission N 2014557 Notary Pubic California San(^" County My Comnn, „areh 24, 20171 Affiant p q t7 IJ opts 5 011u15 �/S?06 1. 3y9, Address a.e. ry Public 0325 concerns this company, give the was separate or community: (If fir t duly kiworn, on hurli athstates: r n g fFb that 'C and that the facts stated 20/11 Notary Public E. MALACHI ELGUERA Commission 0 2014557 Notary P+"` San Luis„ My Comm. Exires Mardi 24, 2017 Name of Child Date of Birth Address Living /Dead Date of Death Name of deceased child Name of deceased child 11. If a deceased child left descendents, give the following information: 12. If decedent left no children or descendents of deceased children, then pleasefu'rnish the follawfrig information a. Give names of parents of decedent: Name Father Mother Address Living /Dead Date of Death b. Give names of brothers and sisters of decedent: Name M.q 1\f4.4. L y A)04-1- Relation Address Living /Dead PALM mkVS NNevApA- L/14 ;4)G Date of Death c. Give names of children of deceased brotheror'sister: Name of Child Child of Date of Birth Address Living /Dead 13. If decedent left no heirs covered by item 12 above, then attach a full and complete affidavit of Heirship of said decedent in narrative form. 1 4 Give locatiort or descrip on of homestead of decedent, as of date of death: J Z7 CE, D o iiL O•• 1 ..")9A) /,g FugisPo, eA 939as 15. As to each tract of land or interest in land owned by the decedent at the time of his death which following information which will be used primarily for the purpose of determining whether property space provided is.,inSufficient, attach exhibit giving information as to each tract). 16. Here briefly state facts and circu (such as being a relative, a close friend, or attorney or agent for, decedent) which will show basis and source of information given above: Ci 0 .5 f Pk/ 1 E. MALACHI ELGUERA Commission 2014557 Notary Public California San Luis Obispo County Pt My Comm. Expires March 24, 2017 1 j n��`� Subscribed and sworn to'before me this d My commission expires: fAtraCt4 1.21 STATE OF COUNTY OF That CAvi t%oQ N l SAN Limt df,i0fO therein are true and correct. M R.n)R/E Lr 6 has Subscribed and sworn to before me this ,eho L was personally and well acqua nted with read the above affidavit by P i 1 T My commission expires: A141 Z 1 I 'ZO (i- sS "SUPPORTING AFFIDAVIT of L� of lawful E. MALACHI ELGUERA Commission N 2014557 Notary Pubic California San(^" County My Comnn, „areh 24, 20171 Affiant p q t7 IJ opts 5 011u15 �/S?06 1. 3y9, Address a.e. ry Public 0325 concerns this company, give the was separate or community: (If fir t duly kiworn, on hurli athstates: r n g fFb that 'C and that the facts stated 20/11 Notary Public E. MALACHI ELGUERA Commission 0 2014557 Notary P+"` San Luis„ My Comm. Exires Mardi 24, 2017 Township 19 North, Range 112 West Section 05: ALL Section 06: ALL Section 07: ALL Section 08: ALL Section 18: Lots 1 and 2, N /2, SE /SE Section 19: E /2, E /2NW, SW /4 Section 20: ALL Township 19 North, Range 113 West Section 01: ALL Section 12: NE /4, NE /NW, NE /SE, SW /SE, SE /SW Section 13: SE /NE, NE /NW, NW /NE Township 20 North, Range 113 West Section 25: S /2, SW /NE Section 36: ALL All located in Lincoln County, Wyoming EXHIBIT A Attached to and made a part of the Affidavit of Heirship for Ray G Hadley Township 20 North, Range 112 West Section 20: N /2NE, SW /NE, N /2SW, SE /SW, S /2SE, NW /SE, NW Section 29: W /2, W /2SE, NE /SE, SW /NE Section 30: SE /NE, E /2SE, W /2SW, SE /SW Section 31: ALL Section 32: ALL 0326 STATE'_ R EOIBIRAR STATE F 1. NAME OF DECEDENT- FIRST 01'.1 20. DECEDENT'S RESIDENCE Ow. .74 bc.IMn f2TCERRb ROMNlJLDOT/CVE, 24. NAME OF SUlVFANO IVOUBF•ROP• -FRIST MARJORfEx r a E R 21. NAME OF FATHEM'AR KRFIN9T RAYMONb 12.. DESC{y0E HOW 22407411 OCCUPREO Para. wNC( ,.0,11.E R 25745 29. MIDDLE.. LYNNE ARCHlEr.�, VW CERTIFICATE OF DEATH ;4 STATE OF OALFORNA USE MACK INK MAY I N] E ANiEWTSQI RAY GENE' HADLEY ANA. ALSO KNOWN AS ma.A.M*1cA r MIST. MIOOIE. LAST) RAYS WHEN yy E. AGE (5. •171 9411 TT. IF 1117 0, gON9 O. SB. RARAYS G HADLEY. 1 4. DATE OF B 08/17/1944 68 r- 1111059. O. BAElli STATE /FOREIGN COUMR/ SOCIAL SECURITY M1M(ERy. I1; E VER NUSNIIAED FORC5M4( TtMApf/LB7WSDIRDP p SETA 4 DYE I. DATE OF DEATH nNE Ekcn E. DOUR (14 WY 4, 4 i'MARRIED;" 10/08/2012 1900 1].EDUCK I."dO,pN MM. WAS DECEDENT 1f0vm,. ,nl yy M 1e. DECE0E'9 RACE Up ry y ltt$.. woman. b Mum ml1 •DOCTORA,TE:1 YE B :r °T .0- F WHITE P 7. 17. USUAL OCCUPATION- 194. N waft b Amp 01 N.. oO lair, :AE TIE 4w MOLECULAR BIOLOGGS1 12. NANO OF SUNNI'S 0A INDUSTRY h0. 0g.a.. se o•'M' r'.a1, ann Way -c). RESEARCH W+Iw .I 77.Cm 1x.000NTYRRDVINCC n.zr cone 21. YEARS ncouNr a.�REroN COUNTRY SAN CUIS'OBISPO g`: SAN,LUIS OBISPO 93405. 8 I CA IPS.NFORMANTS NAME,REUrIONSISP. t. 27. W41 A1 MCEJN3 AMM aAe arY ,ow rat c*y MNM 101 •MARJORIE L'YN IE(FIADLEY, WIFE 127'CERRO,ROMAULDO AVE, ^SAN LUIS 93405 127. DATE mo(MIAoyy LAVOA'NE CERTIFIED COPY OF.VIT REC R STATE 01 CALIFORNIA 0C COUNTY. SAN 'LUIS= OBISPO} DATE.' ISSUED: 'This true and! exact reproduction`of the'docQment officially reglstered&and plat n ills.. theiofflce of :the'SAN-LUIS OBISPO HEALTH 12b TYPE TAMP. TITLE of CORONER DEPUTY C $1111111111ul1Mt MINEMNNp1NIISIMIII BNN LOCAL REOIST+A1NNtVUN L. YEARS IN 20 FAX AU 111.4 ]I 01R N STATE CO his;copv not valid unless preparf a engraved boT'd�r dis }la signature of County Registrar. SS: 000020IDN DATE 45400074 1D.PIACEOFF*.11,l POS'TIGN SCAT:TERAT =SEA yr' 10/12/2612 1, OFF,Y MORRO'BAY; CA"',', 41. TYPE OF DI&POSIV;, 1s) 42. SIGNATURE OF EMBALMER,,.„ J^FNSE AVMDER tR/SEA ,sA"y4 NO r' EMBALvtED f. 44. NAM OF FIINER.LESTABl1]FYEEM !5 /S. UCEHSE .7.8O 4S SIO1UT(AE 4F LwAL REOUITRAN, a s CATEARnVEEkcn REIS•FAMILY MORTU x FI]9'9.. 0 T' '1 Y m PIB(SRENSYEIN,gMC L 071 2/2 01 2' 101.PUCE OF 102, IF anon ONE .t. 11 PE 10]. OTHER THAN HOSPITAL SCIP( ONE SIERRAtt TA7 a .NT °LCD ®fia El wNwLYc Io a y ar. 104. COUNTY 196, A RP55 ON U M. *.M N.* 10 ISV..I and c r, .mb bar. SAN LUI 1 UAYAVE 1 �^xt SAN'LUIS OBI$PO 147C V5D OF DEAIN BMMOYta EM,... y1,M. ut.41.... EM eq., cased 0 DO NOT L9 0541.5 SOCCPCKM ...GATE CAWEY IN RES O FA URE •cl' ,ww .lwaro n. •+mow R=7, RI. Dm 1 t I" x Nn 10D 110. AUTOPSY PERF 5tw wK sy r Ianawn;ulr� A s+ nn MUSED Pi 1t 4.12 �r� ❑YES 112.ORIER SIGE2RCANT CONDITIONS C0NIRIBUMNO TO w NOTReBULT NO IN, HELNDERIYnO WIEN n 01 CORONARY ARTERY, DISEASE WAS CPERATIOV PERFOELAED FOR ANY CONDITION N REM 107 OR 111161 TwN2l al I 11]■ F R3.W1y NtTN•1 Now WAD YES Nil ID.:l111`' ':14701EMU CF INIOVO3 ®(E C69HCCCLAID 115. SIGNATURE AND TnLE of "ERTFER, 114. LN:ENSEI NADER 1117. DATE,, mINNOOyy.. RTE H21R DIM HORAC SIRED NoJ ne C.» SINTO1 G83698 110/11/2012 W P"AAVEkaYY i a:4 nm 400 116 TRW MENDING P.rv91CLW S NM 101114 ANA 10,08/2012 :-10/08/2012 1428 PHILLIPS 203 SANL'UIS OBISPO, CA 93401 119111301P0142111WORICNCIDOVI00TANiDATOEFOR O4E MDR/1E SW®R0.4 DE F.D YYWg2 .+120. INJURED AT WORK? 121. NARY DATE .enaaco, 12E H.11 9INwa1 1 OF 06 O Hwt:il A0ocha0 lb 19119 &Ada mq tiv EprvN t p T,2f 21. PUCE OF INJURY 4, cvm.aclmn me. waded rm.../ CENSUS TRACT br, nny Borenstein. Offic'