HomeMy WebLinkAbout972996STATE OF WYOMING
SS.
COUNTY OF LINCOLN
AFFIDAVIT OF SURVIVORSHIP
I, ROBERT K. JONES, being duly sworn under oath, state as follows:
1. That Diane B. Jones my wife, was tenant by the entireties with me in land in
Lincoln County, Wyoming, more particularly described in the Quit Claim Deed that was
recorded in the Lincoln County, Wyoming land records in Book 412 at Page 747 on June 11,
1998 as Instrument No. 854039. Attached hereto is a copy of that Quit Claim Deed.
2. That Diane B. Jones died on June 25, 2013. Attached hereto is an original copy
of the Certificate of Death issued by the State of Idaho for Diane B. Jones.
3. That pursuant to Wyoming Statutes 2 -9 -102, I certify that the tenancy by the
entireties of Diane B. Jones has been terminated by her death and that title to the above
referenced land is now in the name of Robert K. Jones, a single man.
DATED this 28th day of August, 2013.
ACKNOWLEDGED, SUBSCRIBED AND SWORN TO before me on this 28th day
of August, 2013 by ROBERT K. JONES.
WITNESS my hand and official seal.
M KEVIN VOYLES NOTARY PUBLIC
County of fit., State of
Lincoln Wyoming
My Commission Expires: July 16, 2015
My Commission expires:
ROBERT K. JONE
RECEIVED 8/30/2013 at 11:57 AM
RECEIVING 972996
BOOK: 819 PAGE: 262
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0262
It (1: figtVi
:SS
QUIT CLAIM DEED
ROBERT K. JONES and DIANE B. JONES, Trustees or their successor(s) in trust,
of the R &D Jones Family Trust dated March 31, 1993
Grantors of County of State of Wyoming
hereby QUIT CLAIM to
ROBERT X. JONES and DIANE B. JONES, husband and wife, as tenants by the
entireties
Grantees of
Co
for the sum of One dollar and other good and valuable consideratiogoT
the following described tract of land in Lincoln County, State Wyoming,
to -wit: cD
G)
lD
BOOK 41 ZPR PAGE 7 47
Lot Ninety -eight (98) in Star Valley Ranch Plat Three (3) as platted and
recorded in the official records of Lincoln County, Wyoming.
Ro
LAND TITLE COMPANY
Notary Pu.lic
m
Subject to reservations and restrictions contained in the' United
e
Patent and to easements and rights -of -way of record or in us.
Together with all improvements and appurtenances thereon.
WITNESS the hand of said grantors, this day o ti!i--- A.6'. 1998
Signed in the presence of
co
c,
Diane B. Jones Trustee
r
0
r!
C.)
.Spates
c>
:3)
STATE OF WYOMING
County of I,tfl )4t
On the day ofi u/YLQ A.D. 1998 personally appeared before
me Robert K. Jones and lane B. Jones, Trustees or their successor(s) in
trust, of the R &D Jones Family Trust dated March 31, 1993, the signers of the
within instrument, who duly acknowledged to me that they executed the same.
Commission expires: A; y
Residing in ,c-+,
0263
CERTIFICATIO TAL RECORD,
TYPE OR
PRIM IN
PAPMANENT
b 406 INK
00001 use••
"TtraTRUCTIONS;
NANDB0014
DATE OF
DEATH
CAUSE OF
DEATH
ITEMS 32.38
TO BE USED
FOR EXTERNAL
CAUSES ONLY
IGOraov[R4
K DEATH WAS
,o*o tO OTNEi(:
TX411NATURAL:
CAUSES,
THE CORONER
COMPLETE AND
e1GN THE
:.CERIFlCATE
:STATE'OF.IDAHO:
I DAHO DEPARTMENT bk HEALTH AND WELFARE
BUREAU OF VITAL RECORD$ HEALTH STATISTICS
State of Idaho
CERTIFICATE;OF DEATH
u .r W L. 00 60 crt EwF o .a MAR.upssi En) ••1 W: 7,p0S
1.OECEbENr'S LEGAL'.NAME d y)(Frel„Mpols Las45ufx)
DIANE B. JONES
40 AOE -Lsal Birthday lab.LINDER 1 YEAR 4C UNDER 1 6 DATEOi BIRTH (M613ay7Yr)
Mo Ih 0
0 70 Ys N u IMm lea I OR/0701RA1
t,�-
1 RESIO €NCE •STATE OR FOREIGN'CgUNTRY '7h. COUNTY
WYOMING LINCOLN
t 7d STIR el AND NUMBER.:
'B
LL d. MARITAL STATUS TIME OF DEATH
9. 13 SEC.(JOTV NUMBER,
FEMALE
BIRTNPLACE(dlly snd S71.: Teml OrE f relg Country).
OGDEN, UTAH
I TG OR TOWN
$TARVALLEYRANCH
,7 APT �1D I]I ZIP CODE.:' -.70 INSIDE CITY
83127 LIM1rs7
p SURVMNG SPOUSE S NAME .PI y va maiden name)
M m d but separated Widowed Divorced Never m d un`k- nown ROBE K JONES
,.1I EVER INUS Yt FATMERSNAME (F 1 Mddl Loot. 5 M) j ROBERT
'c ARMEb ,116. BIRTHPLACE (Slate. Temtory. o Foreign Counlryj
EORCEST GEORGE E. BARRY
UTAH
:p 13 MOTN R A DEN NA E(F m (iAi- 1tb BIRTH PLACE (E(le
SM M
U 13A, INFORMANTS NAME (T
34 R ELA ^DNS ^IP TO DECEDENT i 17t. MAILING ADDRESS ]51 eel PO,•NU 4e •Ely Stale ZIp Cadet
ROBERT K. JONES
4.1423AEINDO OF DISPOSITION 16. PLACE OF DISPOSITION (Name and address of cemetery. 16. NAME AND COMPLETE ADDRESS OF'FUNERALFACILITV
rF
a-8unit, i., ®C dm I 1 ry :other PI ce)
❑Don (1 N E tomb 1 :ALACKF.00T CREMATOR
BUCK•MILLER -HANN FUNERAL HOME
17)A moval'(1 !Oho 132 S I SHILLING AVE •825 EAST 17TH STREET 0)0 ((Sp cI4) BLACKFOOT IDAHO 83227 IDAHO FALLS 1041(0 17 8404
3 SIGNATURE 6 FUNERAL SERVICE:LICENSEE OR PERSON ACTING ASSUCM 17b LICENSE NUMB6r(OlYicensee) 18 WAS
ELECTRONICALLY FILED: KEVIN' K :'BODILY M07$7
33 DATE:OF DEATH (Me/LOWV) (Sp n "dnln)
June'25,2013
19e. IF DEATH OCCURRED IN A HOSPITAL: l 19b. IF DEATH OCCURR® SOMEWHERE OTHER THAN A HOSPITAL. :.m'
ll9Inpatient 2 oER(Auto R teM 3 ❑DOA 1...!...pHop lacIty 5❑ Noosing ho eA g lend care ladles 6 Decedent's h 70 Olhe (SD aryl
NAMAEN( p2 rapt tY n+. O 1 01:a d ba 1 1 CITY TOWN LOCATL 4 DEATH OW
AND ZIP CE 22. COUN O
TY F DEATH
EASTERN IDAHO R L M
I IONAPPJCAL CENTER„ IDAHO FALLS ID83404
BONNEVILLE
24 TIM E'OF DEATH 25: DATE PRONOUNCED DEAD (MO/D 5301 r11(:m i0)' 26 TiMEPRONOUNCED DAD'
L c w
PART Enter the W Ieven)o -d In n 27 3 00 5 OFDEATH -0
mpllwlmns -that directly caused the d Ih DONOT enter terminal vane ei4 sTardiat ADPrOk le Inl• al
arii4i r00041brY Nrpst, or yantricularlIbTibefion without showing the 01401022. DO NOT ABBREVIATE Enter only one cause on a line. ,One I I Death,.
IMMEDIATE CAUSE (FI al
dl s orrariCHl F ATH HEART DISEASE 1 MONTH
r 1 sulll p l :OUETO (Rr as a COnievuenre on:
614 w :)1)(y list cashdlil•yr ISCHEMIC BOWEL
�:u rN t a l g to Ina 03 r for ea a was gp ce n: WEEKS OUE'TO
n' I ales on Une.e -Em.r Ins
v6:UNDERLYING'CAUSE ACUTE•RENAL FAILURE"'"' i:t WEEKS
'LAST(re or injury
TZ that Initialed Pa events DUE TO for as a coteradnence 44):
g Tenoning In death)
PERFORMED7 AVAILABLE TO COMPLETE
U 0 m 0 Unknown U ol Pr 0 O Arepnanl Unk cell d6p'naM Thin lh P r
sl': A I ,P ni)uip I el pal
within 42 days oI dsat0 yea ❑"S Idde C..Id not b d ■10 9E'
33 OATS OF INJURY (MOIDayNr) 33. TIME OF INJURY 34. P LACE OF INJURY (De d 1 s 1,0530,1170. sire I C0 61 ct I,
on site,
u'(SOaI) nlhl (24h nur sing home reslauranl. I real. etc.)
,pa 1NJURv.o.y4OpK2
Yes No
34 LOCATIGN :OF INJURY: b
'S1 let. ply/ Town or County
2'0. Code
:tlikli BE HON INJURY O CC UR RED IFTRAN RTA NJU STAT ETHETYPB( S) OFVENIC1 E(S))NVOLVEO(AUlgmpblb,pickup r)1pMrcy44, 4 V brcyUe e1i)
'SPECIFY WHICH VEHICLE; DECEDENTOCCJpleD d pdicabb
TRANSPORTATION 1 311 WAS DECEDENT, DriverSiberalor Pa esnp ]11b, WHAT SAFETY OEVICES($) DIO pECEOENT.USEIEMPLDV7
INJURY 0R•Y I P de 1 a Otn (Specify) 0
Seal bell c safety seal 6.1,;,:i
1 1 Air el S'.; None Unknown
J TIFIER!(Chocko1N::Ot<e based on 0100.4 ap dy(oflliisc rO6cale) i 39b. LICENSE NUMBER
®PMVSICI .:f_J PHYSICIAN/595TAN7 AbVANC5•PRAC710E P066051ONAL'NURSE
..to (00 409 of y 040Vdedgb: p9am occurrdtl:a(4,e 1 dale spit dace, and due.l Ise natural cause(s 9aledc: M -08388
[y DORONEIi
O theta b oTeiminenetOodor nyeOipa4o I mY o p ...n deem burred rlh Time. d* nd pb p,and do 10 12, caysA Y. i J9 DATE S
d a dated a
7 8 ..):2013
slg .ureand Tnl r Miler K D GORMAN M D
ADDRESS. ND F e c_.
J9d N AME gDORE55 AND DP CODE OF CERTIFIER (Type or odd)
CATRicK D. GORMAN, 2QQ1 S. WOODRUFF AVE. STE 12A IDAHO FALLS; JD 83404
40 :REGISTRAR'S SIGNATIIRE :l
40b. DATE SIGNED
,.L/ 9 i 2013
This Is a true and correct:re roduction of the document officially registered and placed'
on file withathe IDAHO :BUREAU OFVITAL:.•RECORDS AND HEALTH STATISTICS.
'Ili
1
I rI J
0 DATE
0•0 ISSUED:
rat
I v�
R' :JAMS AYDELO 1.E
oar ,This•:oopv not valid un =.s prepsr a on engraved border StAtEREGISTRAit:'..
dtsplaying stale seal and signature of the Registrar
'1 PONCOIRee)p7/li "q
x.11 W_1111 MU 0■ I IA1 I LISP