HomeMy WebLinkAbout973916STATE OF WYOMING
COUNTY OF LINCOLN
AFFIDAVIT OF SURVIVORSHIP
SS.
I, Martha T. Roberts being of lawful age and duly sworn according to law upon my oath and
depose and state:
1. That I am of adult age, a resident of Afton, Wyoming, and the Affiant herein.
0062
2. That by virtue of the conveyance which is recorded in the Office of the Clerk for Lincoln County,
Wyoming, located at Kemmerer, Wyoming in Book 101PR on page 600 is recorded a Warranty Deed
dated October 19, 1972, which conveys unto Robert H. Roberts and Martha T. Roberts, husband and
wife, by the entireties, the following property more particularly described, to -wit:
Tract No. 1
The N' /2S' /2 Section 3, T35N R119W of the 6 P.M., Lincoln County, Wyoming.
Tract No. 2
Beginning at a point the southeast corner of the SE' /4NE1/4 of Section 3, T35N R119W of the 6
P.M., Lincoln County, Wyoming and running thence West 120 rods, thence North 56 rods, thence
East 120 rods, thence South 56 rods to the place of beginning.
Tract No. 3
Beginning at a point 30 rods South of the northwest corner of the NW' /4NW1/4 (Lot 4) of Section
3, T35N RI 19W of the 6` P.M., Lincoln County, Wyoming and running thence East 95 rods to
the County Road, thence meandering northerly along the county road to the point of Section line,
thence West 95 rods, thence South 30 rods to the point of beginning.
3. That by virtue of the conveyance which is recorded in the Office of the Clerk for Lincoln County,
Wyoming, located at Kemmerer, Wyoming, in Book 356PR on page 641 is recorded a Warranty Deed
dated July 29, 1994, which conveys unto Robert H. Roberts and Martha T. Roberts, husband and wife as
tenants by the entireties, the following property more particularly described, to -wit:
Part of Section 3, T35N R119W of the 6 P.M., Lincoln County, Wyoming more particularly
described as follows:
Beginning at a point 1550 East and 30 feet South from the West Quarter corner of said Section 3
and running thence East 500 feet, thence South 262 feet, thence West 500 feet, thence North 262
feet to the point of beginning.
4. That said Robert H. Roberts died on the 3` day of September, 2011, and a copy of the original
certificate of death, certified to an a true and correct by public authority in which the original of said
certificate is a matter of record, is attached hereto as Exhibit "A
5. That by reason of death of said Robert H. Roberts and by reason of state statutes, the decedents
interest and title in said property has terminated and title to the real property conveyed thereby has vested
absolutely in Martha T. Roberts continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
Witnesse.mrand.axlelf.i41.so1�--
F+ UNCOI.I1 '.J WYOMING
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Commission Expires: C 0 ri 1
M T. Roberts
The foregoing instrument was subscribed and sworn to before me by Martha T. Roberts this
Ili day of 2013.
L_ f
Notary Public
RECEIVED 10/31/2013 at 9:05 AM
RECEIVING 973916
BOOK: 823 PAGE: 62
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Description: Walker 353 -458 Adjusted
A portion of the properties within Section 3, T35N, R1 19W, of the 6th P. M. Lincoln
County, Wyoming, Being more particularly described as fc,llows:
Beginning at the Southwest corner of the "Edmiston 343 -222" property as delineated on
the Plat record recorded with Receiving number 957293, with said office.
Said point of beginning being 666.46 feet N88 °27' 05 "W from the Baker Engineers
PE /LS 698, 1994 location designated as SE 1/16. S3, also said point of beginning being
658.94 feet S88 °27'05 "E from the Baker Engineers PE /LS 698, 1994 location designated
as CS 1/16. S3.
Thence N88 °27'05 "W 658.94 feet to the Baker Engineers PE /LS 698, 1994 location
designated as CS 1/16. S3;
Thence N89 °33'26 "W 250 feet to the Northwest corner of the Long 580 -40 property;
Thence NO 1 °28'06" 19.39 feet to a point in the "as built" center line of Creamery County
Road 12 -111;
Thence N87 °59'25 "W 91.06 feet along said "as built" center line of Creamery County
Road 12 -111;
Thence NO2 °34'34 "E 1,310 feet to a point in the South line of the "Haley 715 -657"
property, also running parallel to the West property line of the "Edmiston 343 -222"
property;
Thence S88 °39'07E 1000 feet along said "Haley" property line to a point in the West
property line of the said Edmiston property;
Thence S02 °34'34 "W 1328.53 feet along said "Edmiston" property line to the point of
beginning, encompassing 30.4± Acres of land.
Together with and subject to The 60 feet wide Right -of -Way Easement for said
Creamery County Road 12 -111.
0063
UtctUtNI Lt(iAL P1AMe
ROBERT H ROBERTS, SR
.SEX
MALE
SOCIALSECURITY NUMBER
AGE.
77 YEARS
DATE OF BIRTH
SEPTEMBER 17. 1933
BIRTHPLACE
ETNA, WYOMING
PLACE OF RESIDENCE
ETNA, WYOMING
MARITAL STATUS AT TIME OF DEATH
MARRIED
NAME OF SURVIVING SPOUSE (If Ade, maiden name)
MARTHA ;LOU TIDWELL
WAS DECEDENT: EVER IN
U.S. ARMED FORCES?
NO
FATHER NAME
CHARLES SYLVESTER ROBERTS
:BIRTHPLACE
IDAHO
MOTHER =MAIDEN NAME:
MARGARET VERA.HAWKINS
BIRTHPLACE
IDAHO
METHOD OF DISPOSITION
REMOVAL FROM STATE
FUNERAL SERVICE LICENSEE
CRAIG L. GEARY
NAME AND ADDRESS OF FUNERAL FACILITY
NALDER'S FUNERAL HOME,
SHELLEY, IDAHO
DATE OF DEATH
SEPT. 03, 2011
TIME OF DEATH
9:15
P.M.
CITY,TOWN OR LOCATION OF DEATH
IDAHO FALLS, IDAHO
COUNTY OF DEATH
BONNEVILLE
CAUSE OF DEATH (underlying cause last)
a.
SUBDURAL HEMATOMA
:,Approximate Interval Between.
•Onset :and Death
'1 DAY'
DUE TO (oral; a consequence of):
b. FALL
1 DAY
DUE TO (or as a consequence of):
DUE TO (or as :a consequence of):
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting In the underlying cause given above
NONE STATED
WAS AN AUTOPSY
PERFORMED?
NO.
MANNER OF DEATH
ACCIDENT
NAME OF CERTIFIER
JONATHAN D. WALKER
TITLE
CORONER
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
Date Filed
vts
SEPTEMBER 14,
01 Fill IIU !ta
CERTIFICATIO TAL RECORD 4
SUPPLEMENTAL INFORMATION ADDED 10/13/20
STATE OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
2011
C1RTIFICATE OF DEATH
State'FleNo. `2011 0:81::28
DATE OF INJURY':
SEPT. 02, 2011
TIME OF INJURY
1:30 P.M.
PLACE OF INJURY
HOME
'LOCATION WHEREINJURY OCCURRED
2171 COUNTY ROAD, ETNA, WYOMING
DESCRIPTION OF HOW INJURY OCCURRED
(,FELL ON STEPS :HITTING HEAD
This is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS.
OCTOBER 19, 2011
DATE ISSUED
This copy not valid unless prepared on engraved border
'displaying state seal and signature of the Registrar.
PBNCO(000)01 /10
(44A/4
JAMES B. A,YDELOTTE
STATEREGISTRAR
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