HomeMy WebLinkAbout972485Affidavit of Survivorship
I, Terry McCloud, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date of November 9, 2011, for valuable consideration, Robert M. McCloud,
James McCloud, Jean Holladay and Terry McCloud, by deed of that date, which deed was duly
filed of record in the Office of the Lincoln County Clerk, on November 28, 2011, in Book 777, Page
19, conveyed to Robert M. McCloud, James McCloud, Jean Holladay and Terry McCloud, as Joint
Tenants with right of survivorship, the following described land, in the County of Lincoln, State of
Wyoming, to -wit:
Lot 2 of Southland Park, Town of Diamondville, Lincoln County, Wyoming as described on the
official plat thereof, together with all improvements, buildings and appurtenances thereon situate
or in anywise appertaining thereto
That by reason of said conveyance aforesaid, the said Robert M. McCloud, James
McCloud, Jean Holladay and Terry McCloud, as Joint Tenants with right of survivorship, 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 Robert M. McCloud, also known as Robert Mac
McCloud, on the 14th day of July, 2013. That by reason of and upon the death of Robert M.
McCloud, also known as Robert Mac McCloud, title in the above described real property vested in
James McCloud, Jean Holladay and Terry McCloud, as the surviving joint tenants.
Affiant avers and certifies Robert M. McCloud, also known as Robert Mac McCloud is the
identical party named with James McCloud, Jean Holladay and Terry McCloud, as Joint Tenants
with right of survivorship 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 this ea' day of A. c4-cc 2013.
State of Wyoming
ss.
County of Lincoln
,,,00 HUN,"
��315'1ta re
o oeoa00 00 o ,)�I
foUNT1'0FUN9UlN
WITNESS my hand and official seal.
o Axttraiion Expires: l� a71
1 /1/111 3 3 1111` RECEIVED 8/6/2013 at 10:37 AM
RECEIVING 972485
BOOK: 817 PAGE: 327
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
T.R/V C 0
Terry McCloud
Subscribed and sworn to before me, a notary public in and for said County and State, by
Terry McCloud, this L.:0 day of blJ I•" 2013.
otary Public
1
CERTIFIC OF VITAL RECORD
DECEDENT INFORMATION
Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouses Name:
Industry /Business:
Residence:,
Mother's Name:
Facility or Address:
INFORMANT INFORMATION
Name: Jim McCloud Relationship:
Mailing Address: P.O. Box, 295, Kemmerer, Wyoming 83101
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: Utah Funeral Directors Cremation Center, South Jordan, Utah
Date of Disposition: July 18, 2013
FUNERAL HOME INFORMATION
Funeral Home: Crandall Funeral Home
Address: PO Box 6, 105 East Center Street, Karnes, Utah 84036..'
Funeral Director: William W Ball
MEDICAL CERTIFICATION
Medical Professional: Jeffrey S Strong MD, IHC Budge Clinic, 1350 North 500 East,,Logan, Utah 84341
CAUSE OF DEATH
Congestive Obstructive Pulmonary Disease
Due to (or as a consequence of): Metastatic Prostate Cancer
Tobacco Use: Probably Contributed
Medical Examiner Contacted: Yes Autopsy Performed: No
This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V R images in top cycloids,
���"ttttua ultra violet fibers and hologram image of the Utah State Seal, over the words "State of Utah This
)p y! document displays the date, seal and signature of the State Registrar and the County /District Health Officer.
of TFI� atryi
U' 1
Al _W tsr.
i p� t U Y I
is ss• f
.:tr
Date Registered: July 17, 2013
Date Issued: July 17, 2013
July 14, 2013
Logan
72
Kemmerer, Wyoming
No
Lincoln County Government
Diamondville, Wyoming
Kathryn Martin
Logan Regional Hospital
Janice L. Houston, State Registrar
Office of Vital Statistics
I:1 I !VW I it u. I: i
CERTIFICATE OF DEATH
State File Number: 201'3009178
Robert Mac, McCloud
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
Mannerof Death: Natural
II I 11.1 I 111 1111 1 OR
23:55
Cache
April 1., 1941
Male
Never Married
Clerk of District Court
High School or GED
Mac McCloud
Hospital Inpatient
Lloyd Berentzen
Director/Health Officer
County/District Health Department
0328