HomeMy WebLinkAbout974860STATE OF WYOMING
COUNTY OF LINCOLN
AFFIDAVIT OF SURVIVORSHIP AND
TERMINATING A LIFE ESTATE
RECEIVED 1/7/2014 at 11:22 AM
RECEIVING 974860
BOOK: 826 PAGE: 464
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ss.
I, NANCY COMBS, being of legal age and first duly sworn, depose and say as follows:
1. That Liisa Aileen Lynch, the decedent mentioned in the attached certified copy of the
certificate of death, is the same person as Liisa Lynch named as one of the Grantees in that
certain Quitclaim Deed dated June 12, 2006, executed by Robert B. Johnson and Helen M.
Johnson, husband and wife to Nancy Combs, Liisa Lynch, Robert Johnson and Kathryn
Johnson, as joint tenants with rights of survivorship, recorded as Receiving No. 919269, on
June 13, 2006, in Book 623 at Pages 62 and 63, of the Official Records of Lincoln County,
State of Wyoming, concerning the real property situated in the County of Lincoln, State of
Wyoming and described as follows:
Parcel Numbered Forty -Two (42) in the Town of Diamondville, Lincoln County,
Wyoming, as surveyed, platted and recorded. Together with all improvements
thereunto belonging.
Two parcels of land within the corporate limits of the Town of Diamondville,
Wyoming and being more particularly described as follows:
Unit 1: Beginning at the NE corner of Parcel No. 42 of the unplatted portion of the
Town of Diamondville, thence N 75 °11' E, 18.0 feet, thence S 14 °49' E, 90.00 feet
to a point on the northerly line of Parcel No. 41, thence S 75 °11' W, 18.0 feet along
the northerly line of said Parcel No. 41 to the SE corner of said Parcel No. 42, thence
N 14 °49' W, 90.0 feet along the easterly line of said Parcel No. 42 to the point of
beginning. Said Parcel contains 1620.00 square feet.
Unit 2: Beginning at the NW corner of Parcel No. 42 in the unplatted portion of the
Town of Diamondville, Wyoming thence S 14 °49' E, 90.0 feet along the westerly line
of said Parcel No. 42 to the SW corner of said Parcel No. 42, thence N 75°11' E, 90.0
feet along the southerly line of said Parcel No. 42 to the SE corner of said Parcel No.
42, said corner also being the NW corner of Parcel No. 41, thence S 14 °49' E, 25.0
feet along the westerly line of said Parcel No. 41, thence S 75 °11' W, 48.19 feet,
thence continuing S 75 °11' W, 80.6 feet, thence N 14°49W, 105.23 feet, thence N
61 °02'57" E, 40.0 feet to the point of beginning; said Parcel containing 6521.0096
square feet more or less.
TOGETHER with all access easements to said property.
All subject to the prior reservation by The Pittsburg Midway Coal Mining
Company of all mines, minerals, metals, ores, coal, iron, oil and gas in and under said
lands and all mining and extralateral rights, together with the right to The Pittsburg
Midway Coal Mining Company, its successors, and assigns to enter beneath the
surface of said lands and extract any and all minerals, metals, ores, coal, iron, oil and
gas therein, as to all of the above described premises.
Also being subject to all rights of way, easements and reservations of record.
FURTHER Reserving and excepting therefrom, however, unto Robert B. and Helen
M. Johnson, or the survivor the full use, control, income, and possession of the
property for and during their natural life.
2. That the attached certified copies of the certificates of death indicate that Robert B. Johnson
died on November 7, 2013 and that Helen M. Johnson died on September 29, 2013,
therefore, their retained life estate in the property was terminated on those dates.
3. That I am one of the siblings of Liisa Lynch and a Grantee of the June 12, 2006 deed and
thereby am interested in the effective property or the title thereto. Pursuant to 2 -9 -102
W.S. (1980) I hereby make her death a matter of record and certify that upon the death of
Liisa Lynch, her previous estate in the property was terminated.
4. That the certified copy of the certificate of death indicates that Liisa Aileen Lynch died on
June 25, 2012 in Kemmerer, Lincoln County, Wyoming
Dated this 7 day of January, 2014.
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
This Affidavit of Survivorship was subscribed and sworn to before me by Nancy Combs,
this 7 Fh day of January, 2014.
DEBRA A. HANSEN NOTARY
COUNTY OF
LINCOLN
MY COMMISSION EXPIRES
LAC
STATE OF
WYOMING
4lr
0 th
NANCY MBS
NOTARY PUBLIC
My Commission Expires: ,3/3Yia7i5
2
0465
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:_,
Disposition:
Method of Disposition:
Place of Disposition: UFD Cremation Center, South Jordan, Utah
Funeral Home or Facility:
Facility: Ball Family Chapel, Evanston, Wyoming
Cause of Death:.
The immediate cause is listed on the first line followed by any underlying causes.
(a) Metastatic Lung Cancer
(b) Chronic Tobacco Use
Other Significant
Conditions:
Manner of Death: Natural Death
•Certifier:
Type:
Name:
Address:
Date Filed:
Robert B. Johnson
Male Social Security Number:
October 29, 1927 Age at t e Time of Death:
4 r
z Vo
CERTIFICATIO TAL RECORD
731733
STATE OF WYOMING
DEPARTMENT OF HEALTH
November 07, 2013
Diamondville
17 Burgoon Drive
Information:
Diamondville, Wyoming
Diamondville, Wyoming
Widowed
Yes
Herman Johnson
Liisa Sophia Lassila
Nancy Combs
Cremation
CERTIFICATE OF DEATH
Physician
Chad Seiler, M.D.
PO Box 390, Kemmerer, Wyoming, 83101
November 20, 2013
County of Death:
Relationship:
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUED: Thursday, November 21, 2013
This copy ia not valid nnless prepared on paper with an engraved border
State File Number:
Time of Death:
V .0 v
0466
2013-003519
86 years
Lincoln
Daughter
interval:
1 Week
12:00 (Actual)
an?asS M4a04.. 0
James McBride
Deputy State Registrar
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
730669
r
IL CERTIFICATION OF VITAL RECORD.
1,07117
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Decedent: State File Number:
Name: Helen Margaret Johnson
Gender: Female
Date of Birth: April 13, 1931
Date and Place of Death:
Date of Death: •'September 29, 209
City of Death: Diamondville
Location: 17 Burgoon Drive.
Additional Decedent Information:
Windsor, Ontario, Canada
Diamondville, Wyoming
Married Robert B. Johnson
No
Edwin Sohlrnan
Lyyli Junnila
Informant: Robert B. Johnson
Disposition:
Method of Disposition: Cremation
Place of Disposition: UFD Cremation Center, South Jordan, Utah
Funeral Home or Facility;
Facility: Ball Family Chapel, Evanston, Wyoming
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) CVA I
(b) HYPERTENSION
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUED: Tuesday, October 22, 2013
This copy is not valid less prepared on paper with an engraved border.
Social Security Number:
Age at the Time of Death:
County of Death:
Relationship:
Other Significant Hyponatremia, CAD, ANEMIA
Conditions:
Manner of Death: Natural Death Time of Death:
Certifier:
Type: Physician
Name: Jeremy Starr, M.D.
Address: PO Box 390, Kemmerer, Wyoming, 83101
Date Filed: October 21, 2013
V,' latiry
2013-003194
82 years
Lincoln
Husband
Interval:
Approximate :07:00 -±3hrs
James McBride
Deputy State Registrar
0467
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE°IS July 17, 2012
This copy is not: valid unless prepared on paper with an engraved border.
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
J ames McBride
Deputy State Registrar
Decedent:
Nan1e: Liisa. Aileen Lynch
Gender: Female
Date of Birth: July 22, 1956
Date and Place of Death:
Date of Death: June 25, 2012
City of Death: Kemmerer
Location: South Lincoln Medical Center PO Box 390..
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name df Father
Name of Mother:
Informant:
Additional Decedent Information:
Evanston, Wyoming
Kemmerer, Wyoming
Married Kenneth Lynch
No
Robert B. Johnson
Helen Margaret Sohlman
Robert B. Johnson
Funeral Home or Facility:
Facility:
Cause of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
of t r,41"
CERTIFICATION
Physician
Jeremy Starr, M.D.
PO Box 390; Kemmerer, Wyoming, 83101
July 11, 2012
AL RECORD
Social. Security Number:
Age at the Time of Death:
County of Death:
Relationship:
Disposition:
Mettod`of Disposition: Burial
Place of Disposition: Diamondville Cemetery, Diamondville, Wyorfiing
Ball Family Chapel, Evanston, Wyoming
The immediate cause is listed on the first line followed by any underlying causes.
(a) Respiratory arrest
(b) MRSA septic „shock
(c) Cellulitis of face
Other Significant end stage COPD, Hypoxernia
Conditions:
'Manner of Death: Natural Death
Time of Death;'
2012 001986
55 years
Lincoln
Interval:
20:35 (Actual)
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