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Home My WebLink About867969RECEIVED AFFIDAVIT OF DEATH OF COTENI 't4i: *'r 867969 STATE OF WYOMING ss. COUNTY OF LINCOLN BOOK 4 PR PAGE 3 3 1 00 SEP I M JEANN R itENI Ei Ef, W' OM1CwG Alan S. Walker, of Afton, Lincoln County, Wyoming, (mailing address: P.O. Box 1648, Afton, WY 83110), upon his oath deposes and says: 1. That William Albert Kuchler aka William A. Kuchler the decedent mentioned in the attached copy of Certificate of Death, is the same person as William A. Kuchler named as one of the grantees in that certain Warranty Deed dated the 19th day of May, 1970, executed by William A. Kuchler and Ila Bithel Kuchler aka Ila Bithell Kuchler, husband and wife, and recorded June 3, 1970, as Instrument No. 423152 in Book 90 of P.R., Page 407, of the Official Records of Lincoln County, Wyoming, covering the following described real property located in Lincoln County, Wyoming, to -wit: Part of Lot 4 of Block 17 to the Town of Afton, Lincoln County, Wyoming being more particularly described as follows: Beginning at a point which is 6.5 rods North of the Southeast Corner of said Lot 4 and running thence West 6 rods; thence North 3.5 rods; thence East 6 rods; thence South 3.5 rods to the point of beginning. 2. That William Albert Kuchler aka William A. Kuchler, the decedent mentioned in the attached copy of Certificate of Death, is the same person as William A. Kuchler named as one of the grantees in that certain Quitclaim Deed dated the 2nd day of August, 1984, executed by William I. Baetge and Kathleen La Na Baetge, husband and wife, and recorded January 23, 1986, as Instrument No. 649407 in Book 235 of P.R., Page 175, of the Official Records of Lincoln County, Wyoming, covering the following described real property located in Lincoln County, Wyoming, to -wit: All the land in Lot 4, Block 17, of the Townsite of Afton, Lincoln County, Wyoming, Tying and being situate South of the following described portion of the South boundary line of the William I. Baetge tract (subsequently conveyed to Robert Loren Stumpp and Michelle Faye Stumpp, husband and wife, by the entireties) as shown on a plat thereof prepared by Paul N. Scherbel, Land Surveyor (No. 164), as of 26 June 1984, said South boundary line segment of said Baetge tract being more particularly described as follows, to -wit: af8fld JlWlON 'EON `Z Rata :saaldxa uo!sslwwoo �W 000a'a 4•w Sa uaMww &Nooks Imo* won +as* ONIOlf10O '1 01Y1330 'Tsn6ny to Aep qT9 s!qT ew eiojeq `Je)lIeM 's ueiv Aq o} worms pue peq!aosgns Je 'S uely "OOOZ '1sn6ny to Aep 119Z ay} aaLva '0002 30 I. 6 Z 'S'M u! pea!nbaa se „olaaayl al}!} an JO Apedoad p9 }o9lle ay} u! palsaaaTu!„ s! lue!lle peu6!saapun ay} `peseeoep `aalyon>i Ila ps all 4o uos 6u!n!nans 'e se }eql 17 °seoueagwnoue pue sue!! 6uris!xe uayT Aue o} loefgns `6u!o6aao4 ay} u! peq!aosep spuel ay} u! 'aelgon}l y we!ll!M 40 }saga }u! 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Tuellle peu6!saepun ay} }eyl 'E (Teld p!es uo umoys se) loan ueafsojO d!IIlyd eqi 40 aaua09 }seegpoN ay} 01 'au!! i(aepunoq y }nos p!es 6uoie `Taal 66 `M ,0'890L8 N eouay} 6u!uuna pue '17961. aunt gZ to }eld p!es uo umoys se '}Deal e6 }ae8 p!es 4o aauaoo }seat' }nos e 6u!eq osie Tu!od 6u!uui6eq p!es) enueny gpno j pue lean }s swept' to uo!loesaa }u! elew!x0adde an le Tloq uo6exeq tiT!M deo Jelem aallann (OLZ 'oN aoAanans puej paaa }s!6aJ) Ilea '1 URA' ay} WOa4 1994 09'617 'M ,0'89.L8 N eouegl 'Taal 09171.Z '3 «95,91740 N s! 1-10NAA Tu!od e 1e 6u!uu!6a8 TYPE OR PRINT N PERMANENT INK FOR INSTRUCTIONS SEE HANDBOOK DECEDENT INFORMANT DISPOSITION CAUSE OF DEATH LOCAL FILE NUMBER /1. DECEDENT -NAME FIRST IDOLE LAST William Albert Kuchler 4. SOCIAL SECURITY NUMBER 517 -18 -2808 HOSPITAL: ❑hpal1M ¥C49,00410100801 0 0011 !OTHER: 0 711. FACILITY NAME (11 not institution, give street and number) Star Valley Hospital 8. STATE OF BIRTH (II not in U.S. A, name country) Missouri 11. WAS DECEDENT EVER IN U.S. ARMED FORCES? (Specify yes or no) 13a. RESIDENCE -STATE Wyoming 43. INSIDE CRY UNITS? (Specify yea or no) n Natural Accident VR 2 -89 Suicide 1/89 15M N Yes Yes 17. FATHER'S NAME Fast Middle Lest Robert Henry Kuchler 9a. INFORMANT-NAME (Type or Print) Ira Kuchler 190. MAILING ADDRESS STREET OR RFD. NUMBER 20. Burk. Cri ellon, Removal from Stole, Other (Specify) Burial P.O. Box 321; 21a. FUNERAL S As Such 25a. REGISTRAR 29. MANNER OF DEATH 2211. DATE SIGNED (Mo. D Yr.) 22c. HOUR OF DEATH 24. NAME AND ADDRESS OF CERTIFIER (PHYSICIAN OR CORONER) (Type or Print) N Orson D. Perkes IMMEDIATE CAUSE (Final disease o condition 'awning hdeat) OP Sequentially list conditions, if any, leading to immediate cause. Enter 9601(18.9190 45881 (Disease or injury atml initialed events re.uaag h "Wahl LAST a Pending ktveetgellon Ca0d not be Determined 136 COUNTY Lincoln 2015. DATE (Mo., Day, Yr.) /8/93 Acting Number 426 Date Issued October 29, 1993 STATE OF WYOMING DIVISION OF HEALTH AND MEDICAL SERVICES CERTIFICATE OF DEATH 5a AGE -Last Bkthday (Years) 86 Nursing Flonroe la Residence Other (Specify) 9. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED (Specify Married Logger (3c. CITY, TOWN OR LOCATION Afton 4. WAS DECEDENT OF HISPANIC ORIGIN? (Specify no or yes-It yes, specify Cubed Mexican, Peale Rican, Etc.) NOXX Ye. (Specify) DUE TO (OR AS A CONSEQUENCE OF): 30a. DATE OF INJURY (Monlh,Day,Vear) Months 50. UNDER 1 YEAR Days Ter PLACE OF DEATH (Check only one) CITY OR TOWN Hors 7c CITY, TOWN, OR LOCATION OF DEATH Afton 10. SURVIVING SPOUSE (II wile, give maiden name) Ira Hyde 2a. USUAL OCCUPATION (0!w kid of work done during noel of working ile, awn If refired) 15. RACE- Amark:an hdkn Black, WNla Etc. (SpxlIy) White Afton, Wyoming 200 CEMETERY OR CREMATORY -NAME Auburn Cemetery 21b. NAME OF FACILITY (71 (C, 1 8:15 A.M 22d. NAME DP ATTENDING PHYSICIAN IF O THAN CERTIFIER (Type or Print) (Signature) II. /PART L Enter Rif damages, sW or •'cations that cawed death. Do not enter IM node of dyh5 such as cardiac 2 or 'aspiratory 80084 shock, 01 heart tdkea. List only one Caw° on each One. d Decd DUE TO LORVLS A C0N CONSE OF): PART IL OTHER SIGNIFICANT CONDITIONS Conditions contributing to death but not related b cause given In PART I 3011. TIME OF INJURY 30e. PLACE OF INJURY -AI hone, farm, sheaf factory, office building. etc. (Specify) E M 30c. INJURY AT WORK? (Specify yea or no) 2. SEX Male 5c. UNDER 1 DAY Minutes 13d. STREET AND NUMBER 378 Adams STATE LPCODE Number DUE TO (OR AS A CONSEQUENCE 091 Spouse 230. PRONOUNCED DEAD (Mo., Day, yi.) 27, AUTOPSY (Specify yes or no) STATE FILE NUMBER 1 DATE OF DEATH (Mo., Day. Yr.) October 4, 1993 6. DATE OF BIRTH (Mo, 0ay, Yr.) February 16, 1907 12b. KIND OF BUSINESS OR INDUSTRY Timber 19b. RELATIONSHIP TO DECEDENT 83110 204 LOCATION CITY OR TOWN 210. ADDRESS OF FACILITY Nn 304 DESCRIBE HOW INJURY OCCURRED THIS IS TO CERTIFY that this reproduction is a true copy of a record on file in Wyoming Vital Records Services, Cheyenne, Wyoming. This copy is not valid unless it bears a. raised seal and the signature of the Deputy State Registrar is in red. Z; e1/ 7 4# Deputy State Registrar 338 74 COUNTY OF DEATH Lincoln (6 DECEDENT'S EDUCATION (Specify only highest grade completed) kmenlafy/Se000dary (0 -121 College (1 -4 or 5 18 MOTHER'S NAME Fk al Mddie Maiden Surname Mary Alva Mati'ika Auburn, Wyoming Schwab Mortuary 45 Afton, Wyoming 7 o the bast of my knowledge, Pt occluded ate a��rrr��ddd Axe o end d 23e. On IM examination of and /m Investigation, In my opinion death matted to the cause(c161ete4 /��y at the arts and place a aid due to IM camels) elated. (Signature and Thiel C (Signature ture an Tilk) 2311 DATE SIGNED (510.. Day. Yr.) 23c. HOUR OF DEATH 1 1 0 Hospi t-al Lana; At nn, Wy 8'21 1 n 256. DATE RECEIVED BY REGISTRAR (Alo, Day, Yr.) STATE M 23e. PRONOUNCED DEAD (1 M Approximate Hlervel Between Onset and Death r r eh 28. WAS CASE REFERRED TO CORONER (Specify yes or no) Na 301. LOCATION (Street and Number or Rural Roue Number, City or Towns Seta)