HomeMy WebLinkAbout973780State of Wyoming RECEIVED 10/21/2013 at 10:45 AM
RECEIVING 973780
M. BOOK: 822 PAGE: 560
JEANNE WAGNER
County of Lincoln LINCOLN COUNTY CLERK, KEMMERER, WY
Mary K. Mavy of legal age, being duly sworn, deposes and
says: Carol A. Mavy the decedent mentioned in the attached
certified copy of Certificate of Death, is the same person as
Carol A. Mavy named as one of the parties in that certain deed
dated Feb roar 16 1773 and executed by
�DY 7 I�uK'ftz 4vp X39 GC' +/t' rOw r; 1��sf�n O d wiFL
to Carol A. Mavy and Mary K. Mavy as
Husband and Wife, recorded on feViehty 1 7,19'73 with the
Lincoln County clerk as entry number 705/8 in book number 324 page
number 527 of Official Records of Lincoln County, Wyoming, covering the
following described property situated in Lincoln County, Wyoming:
Assessors Parcel No: 3419 234 -02 -011
Dated 9 /a C221I 3
y
cg c a e os( e n'At. 5
,116WAIR 116.161
COUNTY OF STATE OF
UNCCAN "OrtiO NG
AFFIDAVIT DEATH OF JOINT TENANT
PP+% u; :g111Wf.3r w VX.PIIPE5 JUNE •4 201
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Cif. z: 7t Ve:(2
0560
STATE OF WYOMING
714 218
This is a true certification of the document on file in the office of Vital
Statistics Services,; Cheyenne, Wyoming,
DATE 'ISSUED :Tuesd ay, July 30, 201
This ,copy .is not valid unless prepared on paper with an engraved border.
DEPARTMENT OF HEALTH
CERTIFICATE OF DEAT
State File Number:
12:36 (Actual)'
f9'
James McBride
Deputy State Registrar
f 'Ate
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death: November 01, 2d04
City of Death: Afton
Location: Star Valley Care Center
Additional Decedent Information:
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Facility:
Cause of Death:
The immediate cause is listed on the first line followed by any, underlying causes
(a) Cardiorespiratory Failure
(b) Age
i
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
4.) f 1 P' t� 1•
frtHl.. t r fie;
CERTIFICATION OF VITAL RECORD a
rrltf'
Carol Arlow Mavy
Male
August 22, 1917
Lost Hills, California
Thayne, Wyoming
Married Mary Kelley
Yes
Christopher Kip Mavy
Priscilla Marie Guptill
Mary Mavy.
Burial
Thayne Cemetery, Thayne, Wyoming
Schwan Mortuary, Afton, Wyoming
Severe Spinal Stenosis
Physician
Orson D. Perkes, M.U.
110 Hospital Ln, Afyon, WY 83110
November 02, 2004
Social Security Number:
Age at the Time of Death:
County of Death:
Relationship:
'Natural Death Time of Death:'
2004 003074
87 years
Lincoln
Vik
0561
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