HomeMy WebLinkAbout869056tiAEF EIi iYO(`11U4G
I, MARVEL CLOWARD, f /k/a MARVEL HALE, being of law 06-and _PR PAGE' 2 6
duly sworn according to law, upon oath depose and say:
1. That TED A. HALE and Affiant were husband and wife.
2. That by certain Real Estate Agreement, dated August 17, 1992, and filed
with the Lincoln County Clerk's Office on August 21, 1992, in Book 314
P.R., Page 420, agreed to sell real property to Ted A. Hale and Marvel
Hale, as Husband and Wife, the following described real
property, to -wit:
Lot number 149, Plat 18, in the Star Valley Ranch, Lincoln County, State of
Wyoming, as platted in Lincoln County Public Records, also known as 1356
Hardman Road, Thayne, WY 83127.
3. That by reason of the above -said Real Estate Sales Agreement, the said
Ted A. Hale and Marvel Hale became the owners of the said described real
property as husband and wife, which by law conveys rights of
survivorship; and title thereto vested in them continuously from that date
as described in the above Sales Agreement and Deed to the date of death
of the said Ted A. Hale, which occurred on the 25th day of November,
1996, as aforesaid.
4. That by reason of and on the date of death of the said Ted A. Hale
title to the above described real property vested absolutely in the Affiant.
5. A copy of the official Certificate of Death of the said decedent having
been certified by a public authority is hereby and made a matter of record
terminating his interest and title in the estate and the said real property and
is made a part of this Affidavit as Exhibit "A
AFFIANT SAITH NOT FURTHER.
13th October
DATED this day of -der; 2000.
STATE OF WYOMING
COUNTY OF LINCOLN
1 ss
The foregoing AFFIDAVIT TERMINATING INTEREST IN REAL ESTATE
SALES AGREEMENT was acknowledged before me by Marvel Cloward, f/k/a
Marvel Hale, this 1 3 day of eiphirjllkti2& O/ October, 20 00
COUNTY OF r STATE OF
LINCOLN WYOMING
My Commission Expires.. 3 -25 -02
al seal.
My Commission Expires: March 25, 2002
auee f�fi
ARVEL CLOWARD
f/k/a Marvel Hale
RECEIVED
crrt
NOTARY PUBLIC
1
ti
ii
CERTIFICATION OF VITAL RECORD.
TYPE
OR PRINT
N
PERMANENT BLACK
BLACK
all(
FOR
INSTRUC71ONS
SEE
HANDBOOK
CI
VR 2 -89
4/94 15M
CERTIFIER
CAUSE
OF DE AT
Ci"
LOCAL FILE NUMBER
DECEDENT -NAME FIRST
TED
4. SOCIAL SECURITY NUMBER
520 -14 -2326
7e, PLACE OF DEATH (Check only one)
H4 TE6 40 Inpatient 0ER /Outpatient 000A I
7b. FACILITY NAME (d not intern am Q46 aasm and om1e)
STAR VALLEY HOSPITAL
8. STATE OF BIRTH (8 not in USA., name county)
WYOMING
11. WAS DECEDENT EVER IN us.. ARMED FORCES?
(Speedy Ms Or no)
13s. RESIDENCE STATE
WYOMING
13e. INSIDE CITY LIMITS?
(Specify yes or no)
YE S
17. FATHER'S NAME FINN
LOUT S
100. INFORMANT -NAME (Typo a Ake)
MARVEL HALE
100. MAIUNO ADDRESS STREET OR R.F.D. NUMBER
87427 US .HIGHWAY 89
20a. Burial, Crematbn, Removal
from Sate, Sher (Speedy)
At
ow
280. REGISTRAR
22s the bast 06 led. knowledge, the time, date and place and due
to
b the a sh o f Meted.
(Spread. and 7111e)
226. DATE SASSED (Mo., Day,) 22c. HOUR OF DEATH
(�j �y1 6 50 A M
226. NAME OF ATTERW PRYBI 6 THAN CERTIFIER (Type a Pad)
PART I. Enter the demises. (6*
28. or Neplabry am*, eh
IMMEDIATE CAUSE (Fmal
disease or condition
mn1190610 deNh) ea
Sequentially 'bat condition,
If any, leading to Immnedlate
cause. Enter UNDERLYING
CAUSE (Disease or Ia w?
that Initialed evert
resel11r0 m death) LAST
20. MANNER OF DEATH
NO
XS Natural OPending
kweelisstion
Accident
Suicide Could rat be
Determined
14849
I 13b COUNTY
LINCOLN
206. DATE (11/0., Day, W.)
DUE TO
DATE ISSUED'
STATE OF WYOMING
MIDDLE
A
60. AGE -Last Birthday
IYera1
79
14. WAS DECEDENT OF HISPANIC ORIGIN?
(Speedy no or yea d yes, specify
Cuban, Mexican, Puerto Rican, Etc.)
Y; 0 (specify)
xtdie
DEPARTMENT OF HEALTH
e. MARRIED, NEVER MARRIED,
WIDOWED, DNORCED (Sp0086)
MARRIED
300. DATE OF INJURY
(Month, Day, year)
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
130 CITY; TOWN OR LOCATION
AFTON
Lael
HALE
AS A CONSEQUENCE OF):
Months
3017. TIME OF
INJURY
LAST
HALE
06. UNDER 1 YEAR
Deye
0 Nursing Hone 0 Residence 0 Other (SPed/y)
Hours
AFTON
12a. USUAL OCCUPATION (GM NW of work date sang Inca
of waabg gal, men I/ marl)
RANCH MANAGER
CITY OR TOWN
AFTON
200 CEMETERY OR CREMATORY -NAME
or com 5o.I a that aced death. Do not enter Bit nlode of dying, ouch as cardiac
or heart failure. U.t only ale ace 01111.0i1 sic.
c AHIG/,A�( cJ„u,
0U 0 (OR AS A CONSEOIIf fNCE OF)!
PA RT II. OTHER SIGNIFICANT CONDITIONS-Conditions contributing to death but not related to Caw. 0hen In PART 1
M
300. PLACE OF INJURY -At lame, farm, street, factory,
office building, etc. (Specify)
This is a true and exact reproduction of the document on file in the office of Vital
Records Services, Cheyenne, Wyoming.
16. RACE American Indian,
Black, White, E10.
(SPoody)
WHITE
18. MOTHER'S NAME Flat
LOTS
6. DU OR AS SE NCE OF): a
Del �M �r�.LeM,B -n
d.
STATE
WYOMING
30c. INJURY AT WORK?
(Specify yea or no)
2. SE%
MALE
00 UNDER 1 DAY
Minutes
7o. CITY, TOWN, OR LOCATION OF DEATH
10. SURVIVING SPOUSE (0 wife, give maiden name)
MARVEL HALE MILLER
3. DATE OF DEATH (Ma, Day, N.)
NOVEMBER 25, 1996
8. DATE OF BIRTH (Ma, Dey, Yr.)
JULY 1, 1917
126, KIND OF BUSINESS OR INDUSTRY
AGRICULTURE
136. STREET AND NUMBER
87427 US HIGHWAY 89
Middle
M. RELATIONSHIP TO DECEDENT
WIFE
24. NAME AND ADDRESS OF CERTIFIER (PHYSICIAN OR CORONER)(Type a PAN)
HEAD, K PAUL MD 110 HOSPITAL LANE AFTON, WYOMING 83110
.7
$6
STATE FILE NUMBER
ZIP CODE
83110
30d. DESCRIBE HOW INJURY OCCURRED
Lucinda McCaffrey
Deputy State Registrar
This copy 1s not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar.
7d. COUNTY OF DEATH
LINCOLN
16. DECEDENT'S EDUCATION
(Specify only highest grade conaead)
Elementary/Secondary (0.12) Cd(ge (1.4 or 6
9
Mellen Surname
ALLRED
20d. LOCATION CITY OR TOWN STATE
L ,NOVEMBER 30,1'95. AFTON CEMETERY AFTON WYOMING
LIOER8EE Or Person Acting Number 2111. NAME OF FACILITY Number 210 ADDRESS OF FACILITY
SCHWAB MORTUARY 45 44 EAST FOURTH AVE., AFTON
23a On the basis of examination and/or kweellgglbn, In my opinion death occurred
N the tens, date and place end due to the ousels) Rated.
1 yyy$ I SIprI kt0 And Dpe) A
236. DATE SKONED (Ma, Day,
.8i 23d. PRONOUNCED DEAD (Mo., Dey, R:)
wS
23o. HOUR OF DEATH
2611, DATE RECEIVED BY REGISTRAR (Ma, Day, W.)
23s. PRONOUNCED DEAD (Holt)
Approximate
Interval Between
Onset and Death.
27. AUTOPSY (Specify 28. WAS CASE REFERRED TO CORONER
,ea a not (SpeolY yea er no)
NO NO
/y
M
M
301. LOCATION (Street and Number Of Rural Route Number, City or Town, State)
ty
OS �O
12
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p4j M.. 1 i' MANY ALTERATION OR ERASURE VOIDS THIS CERTIFICAT +i} 2 ,l F
61, "l r .x,:; M x" 1 k' p ,.d �1]� c f��� A 1r
EXHIBIT "A"
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