HomeMy WebLinkAbout867293RECEIVED
State of Wyoming LINCOLN COUNTY C` +,..,`r'
County of Lincoln
s' 867293 oo AUG -1 Pri I
9 PRPA GE 4 4 AFFIDAVIT OF SURVIVORSHIP JEANNt WAGNER
KEMMERER. WYOMING
I, Ruth McMinn, being of lawful age and duly sworn
according to law, upon my oath, depose and state:
That under the date of April 29, 1971, for valuable
consideration, Willard A. Chipp, Sr., by deed of that date,
which deed was duly filed of record in the Office of the
Lincoln County Clerk, on September 11, 1972, in Book 101
of Photostatic Records on Page 144, conveyed to Charles
McMinn and Ruth McMinn, husband and wife, and to the
survivor as tenants by the entireties and not as tenants
in common, the following described property, to -wit:
Commencing at the northwesterly corner of Lot
numbered Two (2) of Block Ten (10) of the Original
Town of Kemmerer, according to the official plat
of said town now on file and of record in the
office of the County Clerk and Ex- Officio Register
of Deeds in and for said county, point of
beginning; thence running southwesterly along
Klondyke Street, fifty -eight (58) feet; thence
Southeasterly, parallel to Spruce Place Alley,
in said Block 10, seventy -one (71) feet; thence
at right angle to said Spruce Place Alley twenty
seven (27) feet to the line of Spruce Place Alley;
thence northwesterly along Spruce Place Alley,
ninety -six (96) feet to the point of beginning
That under the date of December 20, 1974, for valuable
consideration, Charles L. McMinn, by deed of that date,
which deed was duly filed of record in the Office of the
Lincoln County Clerk, on December 30, 1974, in Book 116
of Photostatic Records on Page 446, conveyed to Charles
McMinn and Ruth McMinn, husband and wife, and to the
survivor as tenants by the entireties and not as tenants
in common, the following described property, to -wit:
The Lot Numbered Five (5) in Block Numbered
Fifteen (15) in the Town of Kemmerer, Lincoln
County, Wyoming, as surveyed, platted and recorded
That by reason of said conveyances aforesaid, the
said Charles McMinn and Ruth McMinn, Husband and Wife,
became the owners of the above described land, and title
thereto vested in them continuously from the date of
conveyance described in said deeds to the date of death
of Charles McMinn, also known as Charles L. McMinn, on
the 14th day of November, 1999. That by reason of and
upon the death of Charles McMinn, title to the above
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CERTIFICATION OF VITAL RECORD
'ANY ALTERATION OR ER/
IDS THIS CERTIFICATE'A
DECEDENT
CERTIFIER
CAUSE OF
DEATH
Amended Reg 170 Dist 160 8k 68
1. DECEDENTS NAME Middle. LasO
Charles L MC MINN
L. SOCIAL SECURITY 5a. AGE -LAM 5D UNDER 1 YEAR °80.'UNDER 1 DAY
NUMBER
Birthday Wears)
Mos Days Hr ':M ini
520 -05 -3096 82
8. WAS DECEDENT EVER IN 9a. PLACE OF DEATHICAack onlyifn4)
U.S. ARMED FORCES?
O Yes DEN. HOSPITAL
0 Inpatient 0 ER/Outpatient
13a. RESIDENCE -STATE 13b. COUNTY
Colorado Montrose ,r�
13e. INSIDE
CITY
LIMITS?
0 Yes
13A; ZIP CODE. 14' As ItE
86. FACILITY NAME ((r not institution, pive street and numpe
Valley Manor Care Center;
10a: DECEDENTS USUAL OCCUPATION 1D6. KING-OF BUST
(Ow kind of work done during mast of working hie
Do not use retired)
gleCtr
Cif
OV(H. tL
se
20a.. METHOD OF OI,SPOSITIO
O rune) ItE3 Cremation 0 Re rll s tran
p, Donation.0 Other (SpeaM
81401
224. REGISTRAR SIGNAAT
23 TIME F� 24 DAEE
d �oqJ1 M 1 L
4:33 A. t^
26. To the best of my knowledge, death °cowhide! 1
the cause(s) andyEnner as led. L
38:. MANNER OF DEATH
d Natural
0 Accident
o 3
O Homicide
CONDITIONS
IF ANY WHICH
GAVE RISE TD (DI
IMMEDIATE CAUSE
STATING THE
O Pending
Inrestipatipn
O Undetermined
Manner
DUE TO OR:AS A CO4SEQUENCEj0F
UNDERLYING CAUSE.
LAST (c) (c)
DATEISSL1ED
DUE TO OR AS A CONSEQUENCE OF
STATE OF COLORADO
CERTIFICATE OF DEATH
33e. DATE OF.INJURY
(alon1h. Day. Year)
an, F!(ger1O.
31. NAME OF ATTENDING PHYSICIAN IF OTHER THAN CERTIFIER hype/Plinth
33e PLACEOF IN.IURY,X1"
a rep. eta- (Specliil
TO BE COMPLETE( ONLY87 STIFi0lNC 1 rstai3.
ale. place, .iic4It
y,
Signature
28. DATE SIGN
30 NAME. TITLE AND MAILING ADDRESS OF CERTIFIER /CORONER (t ypnt)
John C.. Lambert, M.D. 300
34 IMMEDIATE CAUSE (ENTER ON NE CAU PEA LINEEDF( la1 (DA AN
PART
la)
90. CtTY TFDWN.OR LQCAT( OF,DEATH
Montrose
/INDUSTRY' MARITAL 1i MARITAL STATUS Married.
Never Married. Widowed.
Divorced (Spepilyl
1 Ra Ma rried
STREETANONUMBER
(x 3566 Maryland. Road
(T RA Ame sA INdten 16. DECEDENTS EDUCATION (Specify only highest
:(Seedily)::.: op ads compsntl) Elementary or secondary
Mrou 121 College (13 through 16 or. 17
11
PARENTS
DISPOSITION
17. FATHER -NAME (Fee4 Mlddie, aq
Richard Me Mimi 4 <Y*
PART 026E8 SIGNIFICANT CONDITIONS Conditions contnbyting to 00915 buknol raIthedmOu l
:11 PART 1 le .p. alcohol abuse. opeslty smoa tl.
AAE AN Q,AD1f#ESS 8FAGILIr.')
t Ts al ey gu metal Home, Inc.
5z ortrose, Co. ZI 81401
D TPFILED2MQ+ith, Day Yeal
.y 4 k Novemp dddddd er 23, 1999
Montrose, Colorado zIP: >81401'
3:: DATE OF DEATH (Month, Day. year)
Nauember''14, 1999
8 OATEOF ilIRTN 7. BIRTHPLACE (City and Stale of Forelpn
(Mond Day. Veal Country)
iUne 9, 1917 Kp(mnarrr, 'Wyoming
TO BE COMPLETED BY CORONER
h[Ifasl its mi atkin and/or nwaepation h-ly opinion death occurred at the
to and pU¢e, and due tome cause(sl and manner as stated.
alure
9. DATESIGNED'Montn C*y. Year)
AWE H0
WASCORONER NOTIFIES?
°f as o1 Not
NO
s NT-NAM anoint/sec/ship to deceased
th McMinn -Wife
god or R
y
CMEQ'L J. GARRETT PH D
STATE REGISTRAR
URYOCCORRED
TIQN.(SIreet endNumber a Rural6001 Kumasi': City. County. Slate)
35 AUTOPSY
(T' OFNOI
No
THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT CORY OF THE OFFICIAL RECORD WHICH IS I N MY CUSTODY.
Do not accept unless prepared on'security paper with engraved border displaying the Colorado state
seal and signature of the Registrar. PENALTY BY LAW, Section 25 118, Colorado Revised
Statutes, 1982, if any person alters, uses, attempts to Use or furnishes to another for deceptive use
any vital statistics record. NOT VALID IF PHOTOCQPI D
LOCATION City ntTown, State
seiralory Ai1atlalone
36 IF, YES were findings eonaioered
in eel ,n,lnln2 cause of death?
90 COUNTY OF DEATH
Montrose
12. SPOUSE (II' wile, give lnetden name)
Interval between onset
and death
@Intervetbelween onset
end death