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ss.
COUNTY OF LINCOLN
Mori \Affidavit of Scrivener's Error
AFFIDAVIT OF SCRIVENER'S ERROR
Lot Numbered Three (3), in Block Numbered Four (4), in the Willow
Addition to the Town of Kemmerer, Lincoln County, Wyoming
AND
Lots Numbered One (1) and Two (2) of Block Numbered Four (4), in the
Willow Addition of the Town of Kemmerer, Lincoln County, Wyoming, as
surveyed, platted and recorded.
RECEIVED 11/1/2013 at 2:54 PM
RECEIVING 973979
BOOK: 823 PAGE: 458
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0458
I, Robert T. Mori, Manager of CGT Rental LLC, a Wyoming limited liability company,
being of legal age and first duly sworn, deposes and says as follows:
1. That I reside in the City of Kemmerer, Lincoln County, Wyoming and hereby make this
Affidavit of Scrivener's Error or Corrective Affidavit pursuant to 34 -11 -101 W.S.
2. I have knowledge of the facts set forth herein below in this affidavit as I am the same Robert
T. Mori mentioned in the deed and affidavit that I make reference to in this affidavit and am
competent to testify concerning these facts in open court.
3. As set forth in the Quitclaim Deed dated May 26, 2005, my mother, Georgia M. Mori, Garry
L. Mori, Carol Dean and I acquired real property from Georgia M. Mori. The Quitclaim
Deed evidencing our acquisition was recorded in the Office of the Lincoln County Clerk on
May 26, 2005 as Receiving #908733 in Book 586 at Page 337. The legal description of that
property is properly described as follows:
Hereby releasing and waiving all rights under and by virtue of the homestead
exemption laws of the State of Wyoming
4. That on August 23, 2006 an Affidavit was signed by Garry L. Mori, Carol Dean and myself,
Robert T. Mori making my mother, Georgia M. Mori's death a matter of public record. The
affidavit was recorded in the Office of the Lincoln County Clerk on August 23, 2006 as
Receiving #921634 in Book 631 at Pages, 300, 301 and 302 and it incorrectly states in 2
the date that Georgia M. Mori, Robert T. Mori, Garry L. Mori and Carol Dean acquired the
property as the 26 day of May, 2006 instead of the 26"' day of May, 2005.
Instead of reading as follows:
That on the 26 day of May, 2006, Georgia M. Mori, Robert T. Mori, Garry
L. Mori and Carol Dean, as joint tenants with rights of survivorship, acquired
the following described real property from Georgia M. Mori, a single person:
That paragraph should read as follows:
That on the 26 day of May, 2005, Georgia M. Mori, Robert T. Mori, Garry
L. Mori and Carol Dean, as joint tenants with rights of survivorship, acquired
the following described real property from Georgia M. Mori, a single person:
5. That in the same affidavit of August 23, 2006 mentioned above, 10 states "That this
affidavit is made in accordance with the provisions of Section 2 -9 -102 of the Wyoming
Statutes, and that the Certificate of Death hereunto annexed, and by this reference made a
part of this affidavit, is a copy of the official death certificate of the decedent, Georgia M.
Mori, certified to by the public authority in which such original death certificate is made of
record." The original certificate of death was not attached to the affidavit as asserted.
6. Attached to this Affidavit of Scrivener's Error is a certified copy of the certificate of death
of Georgia M. Mori.
7. Other than those two (2) scrivener's errors that affidavit was accurate.
8. That CGT Rental LLC, a Wyoming limited liability company is the owner and possessor of
the land described herein at the time of making this affidavit and its recordation.
Dated this S� day of 2013.
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
This Affidavit of Scrivener's Error was subscribed d wo o efore me by Robert T.
v lb
Mori, Manager of CGT Rental LLC, this 1 v- day of Tr, fir, 1
.‘o°'� R i atki.
Mori \Affidavit of Scrivener's Error
C?./..0 27(024;
ROBERT T. MORI, Manager
CGT RENTAL LLC
2
q, tiL
NOO'ARY PUBLIC
My Commission Expires: 1 DC 1 L.-
0459
312612
p �4, This is a true certification of the document on file in the office of Vital
Records Services, Cheyenne, Wyoming.
.r l:
DATE ISSUED: July 27, 2006
This copy is not valid unless prepared 011 paper with an, engraved. border;
Brent D, Sherard; D., M.P.H.
Director and State Health Officer
Decedent:
Name: Georgia Polly Mori
Gender: Female
Date of Birth: October 24, 1923
Date and Place of Death:
Date of Death: July 10, 2006
City of Death: Kemmerer
Additional Decedent Information:
Place. of Birth: Senia, North Carolina
Residence: Kemmerer,` Wyoming
Marital Status: Widowed
Name of Father:: Loddie McCoury
Maiden >Name of Mother: Dora Greene
Informant: Robert Mori
Dispdsition:
Method of Dispositibn: Burial
Place of Disposition: Kemmerer Cemetery, Kemmerer, Wyoming
Manner of Death: `Natural Death
Certifier:
Name:
Address:
CERTIFICATIO
STATE OF WYOMING'
DEPARTMENT OF HEALTH
DEATH CERTIFICATE
.Chris Krell, M.D.
711:' Onyx, Kemmerer, Wyoming
Date Filed: July 13,, 2006
State File Number: 2006- 002067
Social: Security Number:
Age at the Time of Death: 82 years 1
Cause of Death:
The immediate cause is listed on the first line followed by any underling causes.
(a) Pleural Effusion
(b) Chronic Debilitation
Other Significant Conditions: Choledochoduddenel Fistula,`Ascites
Time of Death: 06:20
ounty of Death: Lincoln
Relationship: Son
Interval:
Weeks