HomeMy WebLinkAbout973522!fiance Title Escrovt'
P.Q. Box 1367
'Peru rPr N/V 8 1 n1
File No.: 204810
STATE OF WYOMING
SS.
COUNTY OF LINCOLN
AFFIDAVIT TERMINATING ESTATE
I, Mary Susan Griff, being of lawful age and first duly sworn according to law, upon my oath,
depose and state:
1. That I am of adult age, a resident of Lincoln County, Wyoming, and the Affiant herein.
2. That by virtue of the conveyances which are recorded in the office of the County Clerk for
Lincoln County, Wyoming, located at Kemmerer, Wyoming is recorded a Warranty Deed dated
the 26 day of February, 1982, in Book 185PR on page 253, conveys unto Charles W. Albrecht,
Mary M. Albrecht, Mary Susan Griff and Charlotte Ann Johnson as Joint Tenants, the following
described property, to -wit: Exhibit "A"
3. That said Charles W. Albrecht on the 28th day of March, 2013, died and a copy of the
original certificate of death, certified to as true and correct by public authority in which the
original of said certificate is a matter of record, is attached hereto as Exhibit `B
4. That by reason of death of said Charles W. Albrecht by reason of 2 -9 -102 W.S. (1980), the
decedents interest and title in said conveyance has terminated and title to the real property
conveyed thereby has vested absolutely in Mary Susan Griff and Charlotte Ann Johnson
continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
September 30, 2013
Mary Su Griff
State of Wyoming)
County of Lincoln)
054
The foregoing in trument was subscribed and sworn to me by Mary Susan Griff, this 30
day of is /e7' 2013
Witness my an s d o ci eal.
Notary Public
My Commission Expires: o 2e
Lori Kaf n -yN a 'v Pub c
County of
Lincoln
My Commission Expires 212612015
State of
AI Wyoming
RECEIVED 10/1/2013 at 11:42 AM
RECEIVING 973522
BOOK: 821 PAGE: 540
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
CERTIFICATION OF VITAL RECORD
Lloyd Berentzen
Director/Health Officer
County/District Health Department
DECEDENT INFORMATION
Date of Death: March 28, 2013
City of Death: Logan
Age: 91
Place of Birth: Chicago, Illinois
Armed Services: Yes
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
MEDICAL CERTIFICATION
Date Registered: April 10, 2013
Date Issued: April 10, 2013
Wyoming Highway Department
Kemmerer, Wyoming.
Susan A Wieldlick.
Logan Regional Hospital
Janice L. Houston, State Registrar
Office of Vital Statistics
CERTIFICATE OF DEATH
State File Number: 2013004297
Charles W Albrecht
CAUSE OF DEATH
Pneumonia [Onset: 3 Days]
Due to (or as a-consequence of): Septic Shock [Onset: 12 Hours].
Due to (or as a consequence of):
Other significant conditions: Dementia
Tobacco Use: Did not Contribute
Medical Examiner Contacted: Yes Autopsy Performed:, No
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
INFORMANT INFORMATION
Name: Susan Griff Relationship: Daughter
Mailing Address: 62 McGovern Avenue, Kemmerer, Wyoming 83101
DISPOSITION INFORMATION
Method of. Disposition: Removal
Place of Disposition: South Lincoln Cemetery, Kemmerer, Wyoming
Date of Disposition: April 1,`2013
FUNERAL HOME INFORMATION
Funeral Home: Crandall Funeral Home
Address: PO Box 6, 105 East Center Street, Kamas, Utah 84036,
Funeral Director: William W Ball
06:32
Cache
-September 14, 1921
Male
Widowed
Foreman
High School or GED
Charles W Albrecht
Hospital Inpatient
Medic ?l Professional' Douglas Maready MD, Northeastern Utah Medical Group, 210 West 300 North, Roosevelt, Utah
84066
Manner of Death Natural
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 8l R images in top cycloids,
ultra violet fibers and hologram image of the Utah State Seal, over the words "State of Utah This
document displays the date, seal and signature of the State Registrar and the County /District Health Officer.
IflEllIllOI 111 II
05.1
-lam
204810
EXHIBIT "A"
Lot 10 in Blocic 9 of Town of Diamondville, Lincoln County, Wyoming as per the recorded plat
0542