HomeMy WebLinkAbout972909Affidavit of Survivorship
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I, Sigmund Ernst Dlugas, being of lawful age and duly sworn according to law, upon
my oath, depose and state:
That under the date of November 5, 1996, for valuable consideration, Leisure Valley, Inc.,
a Nevada Corporation, by deed of that date, which deed was duly filed of record in the Office of
the Lincoln County Clerk, on December 24, 1996, in Book 392PR, Page 87, conveyed to Sigmund
Ernst Dlugas and Eleonore Elfriede Dlugas as Joint Tenants, the following described land, in the
County of Lincoln, State of Wyoming, to -wit:
Star Valley Ranch RV Park Plat 1 Lot 4 as platted and recorded in the Official Records of Lincoln
County, Wyoming
That by reason of said conveyance aforesaid, the said Sigmund Ernst Dlugas and
Eleonore Elfriede Dlugas as Joint Tenants, 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
Eleonore Elfriede Dlugas, also known as Eleonore Elfriede Lenz Dlugas, on the 30th day of
September, 2011. That by reason of and upon the death Eleonore Elfriede Dlugas, also known as
Eleonore Elfriede Lenz Dlugas, title in the above described real property vested in Sigmund Ernst
Dlugas, as the surviving joint tenant.
Affiant avers and certifies Eleonore Elfriede Dlugas, also known as Eleonore Elfriede Lenz
Dlugas, is the identical party named with Sigmund Ernst Dlugas in the aforementioned deed,
whose death terminated her 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 22 day of I 7.. 1 4 2013.
State of f 6
ss.
County of .x. l r l c
WITNESS my hand and official seal.
My Commission Expires: U -204<
RECEIVED 8/27/2013 at 12:04 PM
RECEIVING 972909
BOOK: 818 PAGE: 758
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ceim
Sigmund Ernst D
Subscribed and sworn to before me, a notary public in and for said County and State, by
Sigmund Ernst Dlugas, this 22 day of 0 7` 2013.
Notary Public
DAVID MICKELSON
ROTARY PUBLIC STATE OF UTAH
Pity Comm. Exp. 12/08/2016
Commission 661183
1
CERTIFICATIO
anice L. Houston
State Registrar
Rev. 6/10
UTAH DEPARTMENTOFHEALTH
Office of Vital Records' Statistics
Salt Lake City, Utah
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DECEDENT INFORMATION
Date of Death: September 30, 2011
City of. Death: Springville
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residences
Mother's Name:
Facility or Address:
INFORMANT INFORMATION
CAUSE OF DEATH
Respiratory failure pleural effusion [Onset: 2 Weeks]
Due to (or as a consequence of): Multiple myeloma
Tobacco Use: Non -user
Date Issued: October 5, 2011
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76
Berlin, Germany
No.
Sigmund Ernst Dlugas
Sewing and Alterations
Sandy, Utah
Elfriede Schulze
1231 South 900 East
411.11 II Waal 1111 ILI ip
TAL RECORD
CERTIFICATE OF DEATH
State File Number: 2011.011795
Eleonore Elfriede Lenz Dlugas
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation;
Education:
Father's Name:
Facility Type:,
Name: Sigmund Dlugas Relationship:
Mailing Address: 8284 South 740 East, Sandy, Utah 84094
DISPOSITION INFORM74TION
Method of Disposition: Burial
Place of Disposition: Larkin Sunset' Gardens,' Sandy, Utah.
Date of Disposition: October 11, 2011
FUNERAL HOME INFORMATION l
FuneralHome: Larkin Sunset Gardens
Address:' 1950 East 10600 South, Sandy, Utah 84092
Funeral Director: Dale J Hickman
MEDICAL CERTIFICATION
Medical Professional: Sean R Curzon DO, 700 West'800 North Suite 220, Orem, Utah 84057
Medical Examiner Contacted: No Autopsy Performed: No Manner of Death: Natural
Husband
12:21
Utah
December 5, 1934
Female
Married
Seamstress
9th Through 12th Grade
Gerhard Lenz.
Daughter's Home
This is an exact reproduction of the facts registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio 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 displ the date, seal and signature of the State Registrar of Vital Statistics.
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