HomeMy WebLinkAbout977482Affidavit of Survivorship
I, George C. Knoll, being of lawful age and duly sworn according to law, upon
my oath, depose and state:
That under the date of March 29, 2000, for valuable consideration, Isabella O.
Philips now known as Isabella O. Lewis, Trustee of the Isabella Philips Trust dated
January 3o, 1991, and Isabella O. Lewis, individually, by deed of that date, which deed
was duly filed of record in the Office of the Lincoln County Clerk, on March 31, 2000, in
Book 443PR, Page 491, conveyed to George C. Knoll and Mary L. Knoll, husband and
wife as tenants by the entireties, the following described land, in the County of Lincoln,
State of Wyoming, to -wit:
A portion of Lot 3 of Block 10 of the Lincoln Heights 4 Subdivision to the
Town of Kemmerer, Lincoln County, Wyoming being more particularly
described as follows:
BEGINNING at the Southeast corner of said Lot 3, thence North along
the Easterly boundary of said Lot 3, a distance of 68.05 feet to the
POINT OF BEGINNING;
thence S89 °51'48 "W, a distance of 57.98 feet;
thence N79 °28'54 "W, a distance of 73.25 feet;
thence North along the Westerly boundary of said Lot 3, a distance of
27.19 feet;
thence East along the Northerly boundary of said Lot 3, a distance of
130.00 feet;
thence South along the Easterly boundary of said Lot 3, a distance of
6.61 feet;
thence West, a distance of 40.00 feet;
thence South, a distance of 10.00 feet;
thence East, a distance of 40.00 feet;
thence South, along the Easterly boundary of said Lot 3, a distance of
24.09 feet to the POINT OF BEGINNING
That by reason of said conveyance aforesaid, the said George C. Knoll and Mary
L. Knoll became the owners of said real property, and the title thereto vested in them
continuously from the date of said conveyance, to the date of death of Mary L. Knoll, also
known as Mary Lou Knoll, on the 8th day of June, 2013. That by reason of and upon the
death of Mary L. Knoll, also known as Mary Lou Knoll, title in the above described real
property vested in George C. Knoll.
Affiant avers and certifies that Mary L. Knoll, also known as Mary Lou Knoll, is
the identical party named with George C. Knoll, in the aforementioned deed, whose
death terminated her interest, title and estate in said real property; and Affiant attaches
hereto, and makes a part of this affidavit, a copy of the Official Certificate of Death of
said decedent, duly certified by the public authority in which said death certificate is a
matter of record.
Dated this day of $c- CET 2014.
State of U
County of
Subscribed and sworn to before me, a
State, by George C. Knoll, this I' day of
WITNESS my hand and official seal.
My Commission Expires:
ss.
This ant iw blip Kagrded by
Rory. Oufl n' tits uronceAgency
of pwnly *0 COURTESY only
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LUCAS C. ROWLEY
NOTARY PUBLIC
STATE OF UTAH
COMM, 651001
COMM, iPi 12.18 -2015
a
ounty and
2014.
1111111
II
11111111111 III III IIII III
orge C. Knoll
977482 7/14/2014 10:52 AM
LINCOLN COUNTY FEES: $15.00 PAGE 1 OF 2
BOOK: 836 PAGE: 139 AFFIDAVIT
JEANNE WAGNER LINCOLN COUNTY CLERK
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•1, DECEDENT'S LEGAL NAME(Include A(AS N any) fPrs1
MARY LOU KNOLL
4 AGE Las1 Bidhda 41' DER 1 YEAR AC, UNDER 1
I I
M ddl Last, Suffix) "2. sex:',.: -I•] :,SOCIAL SECpRITY NUMBER
FEMALE LE,..
DAY 1 S DATE OF BIRTH (MD/D y/Yrl
rii,pire
6, B IA
IRTHPCE(C ty and Wale. Tentt °ry�pr, F °reign Cpu try)
GERMFASK MICHIGAN
OB.TQ)VH
D AHQ FALLS
MoniUNha .Days 1 H eu rs M
16 (ye
RESIDENCE STATE OR FOREIGN CO.UNTRY ,,17b,
1DA140
7 t3TREET ANU NUMBER
1960 MARTHA
e. MARITAL STATUS AT TIME OF DEATH
Married, M aMed: pyl ;operated p vieoyed q 0Iyuced
0610811937
COUNTY
BONNEVILCE
9 SURVMNGSEOUSE!5
APT NO 7f Zli' CODE' Y:' cw'
104,. .::83401•. •._'1.0 ❑u9
NAME;(Ilwile. give maiden A4me1
CI Mover maned Unknown I GEORGE
CHARLES KNOLL
D. EVER IN U S .,1,1a, FATHER'S NAME (F
4RME0
FORCES? A BLE NED MCGAHAN
❑'Y,as ,124: MOTHER'S MAAIDEN NAME
FLOSSIE CLAIRE�
IDs, INFORMANT'S NAME (Type or DHn1)
GEORGE KNOLL
METHOD OF DISPOSITION 1 6:
®,Burial 0 ':V°ma fe ry
Doea9Dn Ealemb:nenl ..:ANNI$:LITTLE
p Removal f rem Idaho: ..:.3810.:E:MENAN
❑•omen (spedry) 'ANNIS;
I le ddle: LA GL
Air
E JONES
PLACE OF DISPOSITON,(Name
Other
IDAHO
N S OR
PETERSON
SuMx('
171 b, BIRTHPLACE (Slate. Territory. or Foreign COUnlry)
MICHIGAN`
reign
OM L I: Suffi 1
.•2b BIRTHPLACE (Slate, TeMlor' p C° ly j
13b, RELATIONSHIP TO DEC E NT roc. MAILING
HUSBAND I 1960
andsddress of cemetery, 16.
TT
BUTT CI.METERY
LORERZQ, HIGHWAY
03442'
ADDRESS (S1ree1 and Number, Clly: Slate, Zi heo.del
MARTHA APT IW4 IDAHO FALLS, ID b34.61::.."
NAME AND COMPLETE ADDRESS OF FUNERAL FA'CILITV
WOO FUNERAL HOME
273'NORTH RIOGE'AVENUE
IOANO FALLS IDAHO' 834
•17a, SIGNATURE OWNER SERVICE LICENSEE
6 ELECTRONICALLY FILED: CHRIS
T G ASS 1
7b.' GCENSE NUMBER (Of nsee)•::.;18. WA'S-0 CAUSE CONTACTED:
PERSON AGi1NG' ?S.SUCH I. 1.
DU .TO CAUSE 6DEATN7.
i: I ..11.10778 :''.:.0 Ya BIN.
I
:PART
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-.,TRANSPORTATION,:
PLACE OF DEATH (19.22)
TH OCCURRED IN A HOSPITAL:I 19b. IF DEATH
1 9a. IF DEATH
1 0 In0a1ie91 2 ER/ OulOallard ❑HOSatpp.(aciliry
CILI AME (I
20.FACIUTY NAME(If, fl91' ladfily.'give sireel a- nd nvnberl
1960 MARTHA 8104 .i.
OCCURRED SOMEWHERE OTHER THAN A HOSPITAL:
5 ❑NUming AYme/Lmg ore Malty 6 ®De ®eenl's home 70 Other (Spedfyl
TON OF OUNTH
N: CITY, TOWN OR LQCA O DEATH, AND ZI P CmE 22. C Y OF DEATH
10480..FALLS';1D 83401 :.BONNEVILLE..
24', 11.1E OF DEATH' OATS •PRONOUNC6 0EA0 IM930aY141.150ell month) 26 ,T1ME PRONOUNCED 0040
23, DATE OF DEATH)Mp/Qa1! 5Dell Ih)
June 6. 2013
'Espm 6 403 :00.04:0 0 Jpne 8;2013
p.:.
enter
one Y
x:06 36
lei1 everns as rard•ac .:ADDmrimate'Interve17,
cause on "pnsal'IO 0ea111:,.::':''
6 MONTHS
I,_,F,nler, the .Chain pl'OVen1 diseases, injuries,
or mrmin canons
without showing
DUE TO Mr as
DUE TO (ore
DUE
OUE T
d'alli
Inai 4,10 37 caused 1`•e death, DO NOT
g.pe a l iolo 9Y. DO NOT ABBREVIATE. Enter oN
IedOiralory art oi
eal, .va0lriWlarrbri9a0pn
'IMMEPIOTE CAUSE 1011 1; 'c 61:;
condition .4j 'B.
disease•or con 4.
rt, esu in death)
Seauatiall,nsrconduloils:
cap
listed I the se'
fisted on l'v,e a. Enter Me.
UNDERLYING CAUSE 'I
injury C
I ry
LASTMisease or ir that initialed the events
l •deam)...
d
Co
R_ i ons
PATII :,Ent s g nifies() h ca nlnbulinO.l
a egese9Vence on:
..r.
nsepuaneo o1.
sa
Q:'.:'..:..
I n Panl
y
Pest
�,.y;.
..1_ -i:::
'28a. WASAN Y'2Bb. WERE AUTOPSY AVAILABLE COMPLETE
PERFORMED? COMPLETE
THE CAUSE OF DEATH?
Yes:....el N° Ye6.. N9
s9 .un... Yi
hl not
u reN1ln in he do(
:FAILURE TO THRIVE
:7e. IF FEMALAged 10 6
29. OID TOBACCO US E
CONTRIBUTE TO DEATH? D 1 magnent.wilh p 41 year N I brAgndoi; ),UI gelignite 4] d
to y L belere 000
el ves Probably 'LI v eg aril 1 lIme uId§ath
I No pmSn'e L but pre9nat11 CI U k dwn'i1 pregnenl"i lhInJhe
No ❑Unknown I wilhin 42 days of death year
I J1 M ANNEp:OF0EAT1
l
Er Nature) HOmldep
d n(.' Pdn1 1) sl gall n
A d 0
mdda C6uld hot. be d
I 5_. d 'e le :I:
72. DATE OF INJURY (IAo/Day/Yrl
(Spell month
INRY:;
l9 LOCATION OF JU
slats
•U- 5Dee) and Numbed Dr L°callon
33. TIME OF INJURY 1 1 34. PLACE OF INJURY (Decadent's home. farm.'slreeL Oanslrvdi °n 410. 1 36. INJURY•AT:.V,IORK7
(24er) nursing home reslauran4 forest. etc)
I Yes No
r City/ TOwn 'Zip Code
Apart m bB
ment N
R SP06TA ON iti y 6.
]T, DESCRIB EHQN I_NJURY DECED NT O C RANSPORTATION e" :r. V;STATE THE TYPFS (S)0F.YFNICLE(5)'INVOLV
SPECIFY YVIICU VEHICLE DECEOFM'OCCUPIED il. O6Kabla
30a. WAS DECEDENT: 0,1 1OOaral °r 0 Passenger 116b. WHAT SAFETY
.[J d Ilan I j Seel beg
INC(OL 0D1..b_
ael
lj .Oi °t°r. d AN. b'cyd.
OEM.6E515) 010 DECEDENT USPJ
❑Child eatery seal ❑Helmet Air Deg Nana Uh ➢npwn
39a. CERTIRER•(Cnem d N pile. based an cafia
el PHYSICIAN PHYSICIAN ASSISTANT
-14 he be9'b(m, kng'Medge, death a E 114, e Imo
CORONER
On the bag 6l examination and /or nv sig 1 1°n,,n my
and manner salad.
s!gnawre and rlue of C 16)3 6 REED I. WARD,
ADORE sS•ANO 21P ,C000 OF CERTIFIER (Type
'REED I. WARD WASHINGTON PARKWAX;STE
l 1h4FOb.115 ale) j j
❑ADVANC ®I?R%+'CTICE
d fe 434804 a d'Ddg 1°'Ihbta Oral eairge()l
PRO'ESSIONAL
a
and
83404:
39b. LICENSE NUMBER
NURSE 0•0Q203
03 )ed.
79 DATE:S33010'
duelo)he (s)
0 I dash° W'p4 at mo d M ai EDbce,
D.O.
or odd)
FALLS, ID
MM Otl ,Y.YY
1 40 REGISTRAR'S SIGNANRE: 1
1
40b DATE
l_4_ 7017
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:JAM 0 YY•'YY
ys
PRIM IN
P0RYA ENT
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60 HOT UTE
,FELTTIP TEN",
vc
INSTRUCTIENS
SEE
HANDBOOKS
DISPOSITION
PLACE OF
DEATH
DATE OF
DEATH
CAUSE OF
DEATH
ITEMS 32 -30
TO BE USED
FOR EXTERNA
CAUSES ONL
(CORONER)
':'IF OEATNVII:3
DUE TO OTHER:
THAN NATURAL
CAUSES,
THE CORONER
'COMPLETE 4N07
:.5ION THE'
filPSSS r a� I
STATE A HO
S
IDAHO DEPARTNIENT'OE;HEALTH AND::WELFARE
BUREAU OF VITAL RECORDS EALT.H S
y 1 1
State ofJdaho.:
CERTIFICATE OF. 4 'DDATH
way A detb f ep osyn MeM
RAISED st L 1'ROg. No.
L' l usco.romu. SAGE kvopaccat,NantATI fi V n vpV 41
This is a true and correof'reproducti n of the document officiallyireggistered and placed
on file with'the IDAHO BUREAU OF VIT AND :HEALTH STATISTICS.
ss prepared on engraved border
d sigriatdre of the Registrar,
TAMS B. AYDELOTTE
STATE REGISTRAR
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CERTIFICATIONS TAL RECORD
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