HomeMy WebLinkAbout976334STATE OF 141 1 o/ 1 7
COUNTY OF /.1NCof-AJ)
SS.
AFFIDAVIT TERMINATING ESTATE
I, SRO c L.2 being of lawful age and first duly sworn
according t law, upon my oath, depose and state:
1. That I am of adult age, a resident of ir/1TAH and the
Affiant herein.
2. That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 66S PR on page it 7 is recorded a
Warranty Deed. The Warranty Deed dated the /ate day of
,TIL 2007 conveys unto
/ARr2.7 S Gt scL d Ti NCu C G/a Husband and Wife as Tenants by
the Entireties with full rights of survivorship the following described
property, to -wit: LOT 2 OF TRIANGLE SUBDIVISION, LINCOLN COUNTY,
WYOMING AS DESCRIBED on the Official Plat Filed on March 7, 2007 as
Instrument atiiiiiiinali gXXK No 927390 of the Records of the Lincoln
County Clerk
3. That said CA/2tLyW Al, 612.01,„/ on the e--o day of
2_011 died and a copy of the original
certificate of death, certified to as true an correct by public authority in
which the original of said certificate is a matter of record, is attached
hereto as Exhibit `B
4. That by reason of death of said CARd47f 6 1"✓ by reason of
2 -9 -102 W.S. (1980), the decedents interest and title in said conveyance
has terminated and title to the real property conveyed thereby has vested
absolutely in/ /4e/t .S GRow -'/$4 C continuously since the death
of the said decedent. 6i20
FURTHER AFFIANT SAYETH NOT.
Dated 21 .q, Oe/
State of C L.'
)ss.
County of T
Th foregoing
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witlie t r tTSi" ai.
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kt w.�:. THOMAS
Cat ,rratcaio n Number 800774
k C.osnrathisIon Expires
Soptembor 15, 2014
Meta of Utah
lLY M ®I® em w fl S) IG l:9 R, RI IOC N Y2 el tni M
My Commission Expires:
e 4 7,g2-✓
instrument „yeas su cribed nd
this day of k c
976334 4/29/2014 10:37 AM
LINCOLN COUNTY FEES: $15.00 PAGE 1 OF 2
BOOK: 831 PAGE: 238 AFFIDAVIT
JEANNE WAGNER LINCOLN COUNTY CLERK
1 111111111111111111 11111111111111 111111111111111 1 III III I II I II!!II1
savor to a by Okairt, O'UA
ry Public
f( STATE OF UTAH
CERTIFICATION OF VITAL RECORD
CERTIFICATE OF DEATH
State Hie Number 2014004263
Carolyn Marie Grow
DECEDENT INFORMATION
Date of Death: March 28 2014 Time of Death: 06:00
City of Death. Provo County of Death: Utah,.
Age 74 Date of Birth February=7, 1940:
•i Pasadena, California Sex Female
Armed Services: No Marital Status 'Widowed;i
Spouses Name Usual Occupation :.Homemaker
Industry /Busmessr. Home, Education: Master's Degree
Residence: Grantsville, Utah Father's ;Name: Charles Alexander :Dawson
Mother's Name :Josephine Carolyn Kayl Facility T ype: Son's home
Facilty or Address. :515 East 3400. Provo
INFORMANT: INFORMATION
Name: Harry Grow Relationship:, Son.
Mailing; Address: 136 W Durfee St, Grantsville, .Utah 84029
DISPOSITION INFORMATION
Method of :Disposition Burial.
Plac of Cris o sltion: Grantsville Cit Cemete Grantsville, Utah
P Y rY.
Date of Disposition: Aril 3, 2014
F UNERAL HOME INFORMATION
F q eral Home :Didericksen Memorial.
A ddress: PO Box;798 Grantsville; Utah;84029
Funeral Director: Jay :R Didericksen
MEDICAL CERTIFICATION
M.edicaI Professional; Michael Rhodes, 475 W:940 N,:; U
CAY SE OF :DEATH:
Intracranial Hemorrhage [Onset: 4 Months]
Other significant conditions: High Cholesterol
T obacco User Non-user
M edical Examiner Contacted Yes; Autopsy Performed: No Manner of :Death: Natural
Date E egistered`.;Apr'ii 1, 2014:
Date Issued Apn12 2014
This is an exact reproduction of the facts registered in the Utah State Office of Vital Records and Statistics
Se ieatu res n' exact pffodual document anClude Intaglio 13ordet, V R iriliages in top oyoloids, aridIntagiio microtext.
r oF .11 h This document displays the date, seal and signature of:the titah Registrar andthe County/District Health Officer
�ri
e r\\
%t I I I III IIIIIII Myron_Bateman
mice L. Houston Directt iHealth Officer
yt „Y State RegistCar 0 6 3 9 9 7 6 2. County /Distrtct:Health Department
Rev: 6/13