HomeMy WebLinkAbout976562File No.: 230212
STATE OF WYOMING
SS.
COUNTY OF LINCOLN
I, George A. Roberts, being of lawful age and first duly sworn according to law, upon my oath,
depose and state:
1. That I am of adult age, a resident of Big Piney, Wyoming, and the Affiant herein.
2. That by virtue of the conveyances which are recorded in the office of the County Clerk for
Lincoln County, Wyoming, located at Kemmerer, Wyoming is recorded a Quit Claim Deed
dated the 27 day of May, 1987 in Book 252PR on page 39 conveys unto George A. Roberts
and Celia L. Roberts, husband and wife, as tenants.by the entireties with right of survivorship,
the following described property, to -wit:
Lot Eleven (11) of Block Eleven (11) in the Town of Diamondville, County of Lincoln, State of
Wyoming, as per the recorded plat thereof.
3. That said Celia L. Roberts on the 21st day of October 2006 died and a
copy of the original certificate of death, certified to as true and correct by public authority in
which the original of said certificate is a matter of record, is attached hereto as Exhibit "A
4. That by reason of death of said Celia L. Roberts 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 George A. Roberts
continuously since the death of the said decedent.
FURTHER AFFIANT SAYETH NOT.
George A( Roberts
State of Wyoming)
)ss.
County of Lincoln)
AFFIDAVIT TERMINATING ESTATE
976562 5/8/20143:41 PM
LINCOLN COUNTY FEES: $15.00 PAGE 1 OF 2
BOOK: 832 PAGE: 135 AFFIDAVIT
JEANNE WAGNER, LINCOLN COUNTY CLERK
1111111111111111111111111111111111111111111111111111111111111111111111111
ry X4.
The foregoing instrument was subscribed and sworn to me by George A. Roberts, this
day of May, 2014
Witness my hand'and officia
a
Notary Public
My Commission Expires: Z,04,./7e2/S
Lori Kalan- Notary Public.
County of Slate of
R, r
Lincoln Wyoming
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My Commission Expires 2/26/2015
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Cause of Death
nne n, n
The immediate .2 is listed oi7,tlie.firsf line followed byignyOhderlying bauSes.4, Interval
a r: Not Recorded
:•Unidentified Maligne6dy
cyniclentifiecrinfectiont
Other SibnifioanLCOnditions:',NiOt Recorded
Manner of Death Natural DeattyA.'"
3.
Certifier:
N
AddreSK
Date Filed .pctober 31;..:.?()Oac,.....
•:;A
7 4101 4-04,„,.
11'
D EATH CE RTIFIC A TE.
:::i •:i::::•:• 1 ....:1::
•11 D e eed ent:' '''''State.:F ile.Ndmber: 2
Celia Lee Roberts
.i..:... —.Female Number:-,:s:
'ate of Birth 1 ,:ge. at the Time of Death 69 years A
Date gno :Place of.,Death:.
I„,.
of De
ate::bf Death Odtober21,•'2006i: County Death
th: T
ity,k)f Death: :,i::;:. „Jaekson'4.---
County
Additiopal Decedent Information
Place of Birth :•GlasgOw,
Residence •:MarbletOrii Wyoming
Marital Status Married Name of Survlvin9 Spouse George A. Roberts
N ame of Father :CeOil*F.!Aniek"
Maiden Name of Mother; Saddler
informant. George A. Roberts
Disposition
Method of DiSpOsitiOn:„:•-••• Cremation
...Place of :Disposition Valley Mortuary pematory,,,,lackpon; Wyoming.
TAT.
DEPARTMENT OF .HEALTH
7,0!`' "Alf an t
323482/
Time of Death 06 30
Th is certification of,the document on file in.die of Vital
Records i ords Services, Cheyenne, Wyoming
r s bAT ISSU November 13, 2006
nQt.valict.usIcss prepared ott paper with.apengt'ayetteorde
litf
LI
Relationship; Husband
Breitt D. Sheraiel,'M.D.M.RI.::1.
DireCtor and ,State Healte'Officer
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