HomeMy WebLinkAbout977228The State of Wyoming
County of Sweetwater
AFFIDAVIT OF SURVIVORSHIP
977228 6/30/2014 10:32 AM
LINCOLN COUNTY FEES: $21.00 PAGE 1 OF 4
BOOK: 835 PAGE: 159 AFFIDAVIT
SS. JEANNE WAGNER, LINCOLN COUNTY CLERK
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COMES NOW Diane Tyler, for and on behalf of Blanche J. Drinkle,
deceased, of lawful age, and after first having been duly sworn on her oath
deposes and says as follows:
1. She is the duly appointed Executor of the Estate of Blanche J. Drinkle,
deceased.
2. Duane Arthur Drinkle, also known as Duane A. Drinkle, died in St.
George, Washington County, Utah, on April 10, 2008, as is more particularly
shown by the certified copy of the Certificate of Death attached hereto and by this
reference made a part hereof.
3. Blanche Jean Drinkle, also known as Blanch J. Drinkle, died in Rock
Springs, Sweetwater County, Wyoming, on May 23, 2014, as is more particularly
shown by the certified copy of the Certificate of Death attached hereto and by this
reference made a part hereof.
4. At the time of death of Duane A. Drinkle, he was the owner with
Blanche J. Drinkle as tenants by the entireties of the following described
property.
LOT 43 IN STAR VALLEY RANCH PLAT 17, LINCOLN COUNTY,
WYOMING AS DESCRIBED ON THE OFFICIAL PLAT THEREOF,
TOGETHER WITH ALL BUILDINGS, IMPROVEMENTS AND
APPURTENANCES THEREON SITUATE OR IN ANYWISE
APPERTAINING THERETO.
5. The ownership as tenants by the entireties of said property vested in
Duane A. Drinkle and Blanche J. Drinkle as a result of a conveyance by
Warranty Deed from Fred Cobb, Jr., the grantor, to "Duane A. Drinkle and
Blanche J. Drinkle, Husband and Wife, Grantees, whose mailing address is 550
Lombard Street, Green River, WY 82935..." Said Warranty Deed is dated June
14, 2004 and was recorded in the Office of the Lincoln County Clerk and
Ex- Officio Register of Deeds on June 29, 2004 in Book 560 at Page 159.
6. Duane A. Drinkle, who died on April 10, 2008 as above recited, is the
same person who is named in said Warranty Deed and whose death terminated
his estate in the above described property. From and after the date of her
death, ownership of said property vested exclusively in Blanche J. Drinkle.
7. As Executor for the Estate of Blanche J. Drinkle, affiant is to marshal
assets for the estate and therefore has an interest in said property. Affiant
makes and submits this Affidavit of Survivorship to make Duane A. Drinkle's
death a matter of record, pursuant to W.S. 2 -9 -102.
DATED this z7 day of 2014.
Acknowledged, subscribed, and sworn to before me this al day of
2014, by Diane Tyler.
Witness my hand and official seal.
Tammara A. Hautala Notary Public
County of C` State of
Sweetwater `r`;;` Wyoming
My Commission Ex•ires March 19, 2018
My Commission Expires: I
oLQ,Lo k dt
Diane Tyler
gidk
Notary Public
2
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death,
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facilitli:
Facility: Vase FunetaChaper Rock 8pringkt.dming,
7fr
Cause of Death
The imrnediate cause is listed on the firSt line followed by at* unden
(a) Respiratory Failure
(b) Acute Bronchitis
,(c) COPD
Other Significant
Conditions:
Manner of Death: Natural Death=
Certifier:
Type: Physician
Name:
Address:
Date Filed:
773992
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4,4
CERTIFICATION OF VITAL RECORD
Blanche Jean Drinkle
Female Social.SeCuritY Number:
November 30, 1936 Age at the Time of Death:
No
Jacob °very
Traccia FeSSIer...:
Diane Tyler
Hypertension
Terry Donaldson, M. D.
CERTIFICATE OF DEATH
State File Number:
tatistics Services, Cheyenne, Wyoming.
This Is a true certification of the document on file M the office of Vital
DATE ISSUED: Wednesday, June 18',.2014
This copy is not valid unless prepared on paper withun engraved border.
1204 Hilltop Drive, Suite 108, Rock SpringS, VVYOrhing; 82901
June 17, 2014
ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE
at t't% -Ito
',..lames McBride
Deputy State Registrar
77 years
SVveetwiter
2014-001771
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ty: •.YYV::.. Y:t.:r..Y
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DECEDENT INFORMATION
Date of Death: April 10, 2008
City of Death: St. George
Age: 76
Olwein, Iowa
Yes
Blanche Jean Overy
Minning
St. George, Utah
Bertha Lydia Damon
Kolob Care Center
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
INFORMANT INFORMATION
Name: Blanche Drinkle Relationship:
Mailing Address: 840 Twin/ Lake Dr #227, St. George, Utah 84770
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: Options Cremation; Hurricane, Utah
FUNERAL HOME INFORMATIOh
Funeral Home: Spilsbury Mortuary
Address: .,1.10 South Bluff, St
Funeral Director: .Edward'A Spilsbury
MEDICAL CERTIFICATION
Certifying Physician: Jane G Manalo MD, 272 E. Center St., Iviria, Utah 84737,,
Lr
CAUSE OF DEATH
Respiratory failure [Onset.1 Month]
Chronic obstructive pulmonary` disease [Onset:?1 "Month]
Pneumonia [Onset: 1 Month]
Chronic Lymphocytic Leukemia
Tobacco Use: Unknown;
April 10, 2008
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CERTIFICATION OF VITAL RECORD';
CERTIFICATE OF DEATH
State File Number: 2008004245
Duane Arthur Drinkle
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
Date of Disposition: April 14, 2008.:.;,
Medical Examiner Contacted: No Autopsy: Perforrned: No T Manner of Death: Natural
This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include:intaglio Border, V R images in top cycloids,
\‘%"%11 ultra violet fibers and hol image of the Utah State Seal, over the words "State of Utah''. This
1 P ,�rTN Es lug lj document displays the date, seal and signature of the State Registrar and the County /District Health Officer.
4
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WAS 7 •..1.111 1--11
Barry E. Nangle, State Registrar
Office of Vital Statistics
II! II
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04:15
Washington
June 22, 1931
Male
Married
Engineer- Draftsman
High School or GED
William Arthur Drinkle
Nursing Home /Assisted Living
Wife
"1111 •1111- 1111 1111-'•- _..1111-
ANY ALTERATION, OR ERASURE VOIDSTHIS CERTIFICATE j ,„:11-1
David W. Blodgett
Director /Health Officer
County /District Health Department
11 1 St
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