HomeMy WebLinkAbout976730State of Wyoming
County of Fremont
AND:
ss
Charity Ann Taylor, a/k/a Charity A. Taylor
AFFIDAVIT OF SURVIVORSHIP
I, Charity Ann Taylor, a/k/a Charity A. Taylor, of lawful age, being first duly
sworn upon oath, depose and state as follows:
1. This Affiant is the joint tenant of LaVoy Olney Taylor, a/k/a LaVoy O. Taylor,
that this Affiant and LaVoy Olney Taylor, a/k/a LaVoy O. Taylor were joint tenants with
full rights of survivorship until the death of LaVoy Olney Taylor, a/k/a LaVoy O. Taylor
on January 13, 2014.
2. Said Decedent died at Riverton Memorial Hospital in Riverton, Wyoming on
January 13, 2014 which fact of death is corroborated by the Certificate of Death, duly
certified by the State Registrar of Vital Statistics, which Certificate is attached hereto and
by this reference made a part of this Affidavit.
3. This Affiant and Decedent acquired by a Mineral Deed from Charity Ann
Taylor, a/k/a Charity A. Taylor, and LOT's Family Trust Dated April 7, 1988, Charity
Ann Taylor, Trustee and LaVoy O. Taylor, past Trustee of LOT's Family Trust dated
April 7, 1988, and LaVoy O. Taylor, individually, the real property described herein:
All mineral rights and oil and gas rights, including bonuses and royalties, together
with the right to enter the property for the purpose of developing and marketing
said rights, in the following described properties in Lincoln County, Wyoming,
to -wit:
Township 24 North, Range 119 West, 6 Principal Meridian, Lincoln
County, Wyoming:
Section 18: Lot 16; W'/2SE'/4; SE'/4SE' /4;
Section 29: Lot 7;
Section 30: S' /2NE'/4; SE'/4NW1/4; El /2SW' /4; W1/2SE'/4;
Containing 532.99 acres, more or less.
Tract Seventy -Three (73) (Originally described as W' /4SE' /4, Section 8),
and Tract Sixty -Seven (67), (Originally described as N' /2NE' /4 and E' /ZNW' /4 of
Section 17), all in Township Twenty -four (24) North, Range One Hundred
Nineteen (119) West of the Sixth Principal; Meridian, Lincoln County, Wyoming.
Containing 242.93 acres, more or less.
976730 5/22/2014 9:55 AM
LINCOLN COUNTY FEES: $18.00 PAGE 1 OF 3
1 BOOK: 832 PAGE: 800 AFFIDAVIT
Affidavit ofSurvivorship JEANNE WAGNER LINCOLN COUNTY CLERK
1111111IllillIIII111111IIIIIIIII111IIIllIIIII1111111111 III1111111111111
AND:
Lot 12, of Section 13, and Lot 23, of Section 14, in Township 24 North,
Range 119 West of the 6 Principal Meridian, Lincoln County, Wyoming.
Containing 70 acres more or less.
which Mineral Deed was dated 07/07/2008 and recorded 08/13/2008 in Book 702, Page
317 as Receiving 941269 in the office of the County Clerk of Lincoln County,
Wyoming.
4. That by reason of the death of said Decedent and the status of the parties on
the date of said Deed and the continuation of such status until the death of the Decedent,
the estate in joint tenancy with full rights of survivorship by the entireties in the above
real property was terminated on January 13, 2014 and this Affiant is now the owner of
said real property interest.
5. This Affidavit is made for the purpose of furnishing a recordable document
showing the termination of the estate and the ownership of said property interest in
Affiant.
Dated this of 2014.
Before me appeared Charity Ann Taylor, a/k/a Charity A. Taylor and being first
duly sworn by me upon her oath says that the facts alleged in the foregoing instrument
are true.
Dated this day of Li Y 2014.
REVA L. HILL Note
County of
Fremont
My Commission Expires Oct. 25, 2.
My ommission xpires:
Affidavit ofSurvivorship
Charity Ann Taylor, a/k'a Charity A. Taylor
2
Charity Ann T
ry Public
A. Taylor
DEPARTMENT OFHEALTH
Social Security Number:
Age at the, Time of Death:
77 years
Daughter
ami¢S
games McBride
Deputy State Registrar
atrait
Dece
:Name:
Gender:
Date
`:::Date and Place of Deat
=Date of Death:'
-City. of Death:
=ocation:
dditional Decedent Inform
Gi la ,e o Birth:
Residence
Marital Status"
Armed Forces:
Name of Father:
Name of Mother
Informant:
isposton::
ethodbf Disposition:
ace of Disposition
Funeral Home or.Facili
•'Facility:
Otheyy Significant
ondltions
anner of Death
;Certifier:
:Type:
:Name:
Address:.:
Filed:
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4 CERTIFICATION TAL RECORD
7 4 71 8
LaVoy Olney Taylor
Male
February 12, 1936
January°13, 2014'
Rivertqh
Riverton IMemoriaf'Hos itel 21
ation:
•February06, 2014.
Cokeville, Wyoming
Riverton, Wyoming
Divorced
No
1NIlliam Richard Taylor
Charity May:Bransorl:
Charity Taylor
Natural Death
Burial
Cokeville Cemetery, Cokeville\Wyoming
Davis Funeral Home; Riverton; °Wyoming
Causeof Death
The imfnediate cause is listed; on the first line followed by any underlying cause's.
(a).PNEUMONIA
(b);END ST DEMENTIA
CONGESTIVE HEART FAILURE,,DESITYDRATION ESOPHAGEAL/LARINGEAL CANCER
•Physician
Aida Poison, M.D.
2100 Sunset 82501
This is a true certification of the document on file in the office of Vital
Statistics.Services;:Cheyenne, Wyoming:
DATEISSUED: Thursday, March, :06,
This copy is not.vatid unless prepared op paper with.an engraved,border. y:
00`'Sunset Dr.
State File Number:
County ofDeath:
Relationship:
Time bf Dea h.,
E
2014= 00 0280.
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