HomeMy WebLinkAbout972329AFFIDAVIT ESTABLISHING SURVIVORSHIP
OF JOINT TENANT
Mitchell Ryan Buday being first duly sworn, deposes and says:
1. This Affidavit is given, pursuant to Sections 2 -9 -102 and 2 -9 -103 Wyoming
Statutes 1977, as amended, to establish the survivorship rights of the surviving joint
tenant and to establish prima facie evidence that all facts recited herein are true for the
purpose of such legal effect as may result therefrom by operation of law, pursuant to
Sections 2 -9 -102 and 2 -9 -103 Wyoming Statutes (1977) as amended.
2. A Warranty Deed dated August 31, 2010 was recorded on August 31, 2010
in Book 752, page 878 in the Office of the Lincoln County Clerk in Kemmerer,
Wyoming, evidencing ownership by Mitchell Ryan Buday, a single man, and Mitchell
C. Azar, a single man, as joint tenants of the following described property, namely;
Lot Number Ten (10) of Three Rivers Meadows Estates, Subdivision "A"
according to the plat thereof as filed in the Public Records of Lincoln
County, Wyoming.
3. Mitchell C. Azar died on the 5th day of June, 2013, and his death was duly
registered as evidenced by the certified copy of the Certificate of Dea attached hereto.
STATE OF
COUNTY OF
COUNTY OF
TETON
DATED this ZS day of July, 2013.
IN
The foregoing instrument was subscribed and sworn to before me this g s
day of July, 2013 by Mitchell Ryan Buday who does verify that the foregoing statements
are true and correct to the best of his knowledge.
WITNESS my hand and official seal.
LIZ JORGENSON NOTARY PUBLIC I
STATE OF
WYOMING
MY COMMISSION EXPIRES: NOVEMBER 9.2016
Mit ell Ryan Buday
i/A 1k4
Nota c
r
My C m i ion expires: /11 I
RECEIVED 7/30/2013 at 2:28 PM
RECEIVING 972329
BOOK: 816 PAGE: 727
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0 7 2 aS
CERTIFICATION 1 OF DEATH
STATE FILE NUMBER: 2013080958
DECEDENT INFORMATION
NAME C AZAR
i DEATH: June 5, 2013
DATE OF BIRTH: June 20, 1933
PLACE OF DEATH: HOSPICE
FACILITY NAME OR STREET ADDRESS: SUNCOAST HOSPICE CENTER SOUTH PINELLAS
LOCATION OF DEATH: ST PETERSBURG, PINELLAS COUNTY
SU S POUSE;!;ECEDENT'S RESIDENCE AND HI M
Y INFORATION'`
ila[ iL'I,: III ino.
�1 :MARITAL STATUS DIV RCED
SPOUSE: NONE '.I
RESIDENCE: 634 PONCE DE LEON DR., TIERRA VERDE;. FLORIDA 3371;5, UNITED'STATES
OCCUPATION, INDUSTRY: PROPRIETER, SELF EMPLOYED
RACE: X White _Black or African American Asian Indian ._Chinese _Filipino
N
American Indian or Alaskan -Tribe: Vietnamese
''_i6• m
Guamian or Chamorro Saoan. _Other Pacific Isl
HSPANIC HAITIAN ORIGIN? NO NOT OF HISPANIC ORIGIN
II
g4,U BA CHELORSJDEGREE (E.G., BA, AB,[BS) EVER IN U.S: ARMED FORCES?I PARENTS AND INFORMANT INFORMATION
FATHER: CHAFIE 'EL-AZAR
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INFORMANT'S ADDRESSh'1 BOSTON POST RD, SUDBURY, MASSACHUSETTS 01776, UNITED STATES
PLACE OF ION AND FUNERAL FACILITY IN
PLACE OF DISPOSITION: SOUTHEASTERN CREMATORY
CLEARWATER, FLORIDA
METHOD OF DISPOSITION: CREMATION
FUNE DIRECTOR /LICENSE NUMBER: GERALD F SCIWEIZER, F048406
FUN FACILITY: MOSS FE FUNERAL HOME 8', INDIAN ROCKS F041198
13401 INDIAN ROCKS RD, 1 ARGO,VVFLORIDA 33774
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CERTIFIER INFORMATION
TYPE OF CERTIFIER: CERTIFYING PHYSICIAN
TIME OF DEATH (24 hr): 2050
CERTIFIER'S NAME: TAHIRIH THEONE JENSEN
CERTIFIERS LICENSE N yin, R` 0S10394
li, 'IIII I'
,NAME OF ATTENDINGIP I SI IAN (If other than Certifier);. TAHIRIH JENSEN
l Ir,
E OF DEAT A'ND INJURY INFORMATION
PRO MANN O F` DEATH: NATURAL
CAUSE OF DEATH PART I and Approximate Interval: Onset to Death:
a, MALIGNANT NEOPLASM OF BLADDER WITH METASTASES TO THE BONE
d
THIS DOCUMENT HAS A LIGHT BACKGROUND ON TRUE WATERMARKED PAPER. HOLD TO LIGHT TO VERIFY FLORIDA WATERMARK.
OFFICE of VITAL, STATISTICS
me
[PART II Other significant conditions contributing to death but not resulting in the underlying cause given in PART I :i
1; ji!''
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AUTOPSY PERFOR ED? NO AUTOPSY FINDINGS AVAIL44p�LE�TO COMPLETE CAUSE OF DEATH?
DATE OF SURGERY: ,DID TOBACCO USE CONTRIBUTE TO DEATH? UNKNOWN
REASON FOR SURGERY:
IF FEMALE,' WAS DATE!ONINJURYSNOT APPLICABLE (THIN THE PAS TIME OF'INJURY (24 hr): NOT APPLICABLE INJURY AT WOR ?IIi �I llll
!PION OF INJURY: 1 „II
•RIBE'HOW INJURY OCCURRED:
PLACE OF INJURY:
IF',TRANSPORTATION INJURY, Status of Decedent:
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J ,State Registrar
DATE ISSUED: June 12, 2013
STATE FILE DATE: Jul 11, 2013
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SEX: MALE SSN: s il illil I li ''CyE 079 YEARS
BIRTHPLACE: BOSTON, MASSACHUSETTS, UNI D STATES
DH FORM' 1947411/11)
Native Hawaiian
Othe{ Asian:
i Other'
MEDICAL EXAMINER CASE NUMBER: NOT APPLICABLE
Type of Vehicle:
THE ABOVE SIGNATURE CERTIFIES THAT THIS IS A TRUE AND CORRECT COPY OF THE, OFFICIAL REOORD ON FILE IN T1i OFFICE
'THIS DOCUMENT IS PRINTED OR PHOTOCOPIED ONI H{�
,$pppprrY PAPER WITH WATERMARKS b F TjE GREAT
WARNING: SEAL OF THE ST. TE OF FLORIDA. Dp NOT ACCEPT�('�ITUT.VERIFYING TIE PRESE}JCE CFI1�IE WATER-
MA THE DOCUMENT FACE CONTAINS A MULTIC, epp:RED BAC. GROUND, GOLD EIdBOSBED SEAL, ANp
THERMOCHROiv!ICiFL. THE BACK CONTAINS SPECIAL LINES WITH TEXT. THIS DOCUMENTWILLNOT PRODUCE,
COLOR COPY
le'7
CE
TION OF VITAL RECORD
0
COUNTY: PINELLAS
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