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Hiokman
SINCE 1904
I, CAROL NELSON HANDY, being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America over the age of 21 years, and a
resident of UTAH.
That I was well and personally acquainted with E. LADELL HANDY in that certain
Warranty Deed dated April 1, 1986 and recorded in Book 237PR, at Page 360, as Filing No.
652879, in the office of the Recorder of Lincoln County, Wyoming.
That I know of my own knowledge that E. Ladell Handy in the said deed and Ernest La
Dell Handy mentioned in the attached Certified Copy of Certificate of Death was one and the
same person.
This affidavit is intended to terminate the joint tenancy of said E. Ladell Handy in the
following described property:
LEGAL DESCRIPTION
AFFIDAVIT
978084 8/21/2014 3:35 PM
LINCOLN COUNTY FEES: $18.00 PAGE 1OF 3
BOOK: 838 PAGE: 226 AFFIDAVIT
JEANNE WAGNER, LINCOLN COUNTY CLERK
Tax Roll No. 12- 3518- 31 -1 -01- 009.00
111111111011111111111111111111111III11111111111111111111111111111111III11111111
PLAT NINE (9) LOT FIFTY -NINE (59) IN STAR VALLEY RANCH AS PLATTED AND
RECORDED IN THE OFFICIAL RECORDS OF LINCOLN COUNTY, WYOMING.
vim
64098
Dated this day of August 2014 A.D.
STATE OF UTAH
County of Agi(
SS
On the day of August A.D. 2014 personally appeared before me CAROL NELSON
HANDY
The signer(s) of the within instrument, who duly acknowledged to me that he /she /they executed
the same.
Commission expires: i I d s
Residing in: U Notary Public
AMBER.LCE 1E
Notary Pdbllo
State Utah
Comm. No 611015
My Comm. Expires JUI-27, 2015
INDIVIDUAL ACKNOWLEDGMENT
vlm
f 1
SID(
MAL
'SOCIAL SECURITY NUMBER
..AGE
82 .YEARS if.:.
DATE OF BIRTH
VtpiltJARY.3, 1929
BIRTHPLACE
HEYBURN, IDAHO
PIACEORPIESIDENDE
GLENNS FERRY, IDAHO
mouTAL STATUS AT Time OF DEATH
MARRIED
..),4\t‘i.1.:. EOFSURVIV1140pCIU.S4/1/ We, maiden name)
C ...:*f .!ggscirv....
WAS DECEDENTEVER IN
U.S. ARMED FORCES?
NO
(FATHER NAME
ERNEST W. HANDY
BIRTHPLACE
IDAHO
MOTHER MAIDEN NAME
EDITH BAILEY
witrtinAcE
IDAHO
METHOD OF DISPOSITION
BURIAL
FUNERAL:SERVICE LICENSEE
JERRY 4.,.. 10.04
NAME ANDADDRESS OF FUNERAL FACIUTY
ROST FUNERAL HOME, MOUNTAIN HOME, IDAHO,.
>DATE
OF DEATH TIME OF DEATH
FEB. 05, 2012 7A0 P.M..
'ClittOWNOR Lognoni.cT.DEATH
01 S:P.:', .4
COUNTY OF DEATH
ADA
CAUSE OF DEATH (underlying cause last) ApproXiMate Interval Behvearl
'Onset and DdaUi
CARPI OGENI SHOCK 1 WEEK
DUET° (Et alb a tolisegueace �f)
1 WEEK
'ACUTE MYOCARDIAL INFARCTION
DUE TO (oiad a cancequedca ol):
a.
CORONARY ARTERY DISEASE
YEARS
ou4ro or tiff a 'onsoquonpo 0;
cl.
OTHER SIGNIFICANT CONDITIONS CONTRISUTING TO DEATH but liouesuningIn thi:undodyIng cauld.:.givabA0Y9::
CONGESTIVE HEART FAILURE
WAS AN AUTOPSY
PERFORMED?
NO
MANNER OF DEATH 1
NATURAL
NAME OF,CERTIFIER
STEFANIE J. FRY,.M.OV
TITLE
PHYSICIAN
00.RONERSOS.Sa01104::0ERTIFJCATIQN IF NECESSARY
,.._...,----4-0.---pg.4.-------.7.—.-,-,--....A,.,.,...:m.:m."-41,:vgn.• 714Eig'' ETINA
A 5
r- =:''''N'tiaMmiggAr; ..,4,.,..—.- ----.d3sa 0- '';:4W- ::::::41 4 1 '-'x--,-, ,,,,-.3m-----___-----------.--
DATE OF INJURY
TIME OE INJURY
PLACE °MOWRY
INAWRY AT
VVORK?
LOCATION WHERE INJURY OCCURRED
711,46-prqpi ,Fr/r1M.4.:r
.•404,1,7 n
.'CERTIFICATIOIV:OVIIITAL RECORD:
.:444PO4.34,14 WW1 Vo4 !Pt SGV4:40:44 V4A11.144..p wv. r •7.•
p■friw MUM
Date Filed
DECEDENT LEGAL NAME
FEBRUARY 09, 2012
ERNEST LA DELL HANDY
.DESCRIPTION OF HOW INJURY OCCURRED
STA
IDAHO DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
This is a true and cori.0.91.1fPlYroclii0on of the dfiOmeni cdOlfilly:rtiagiefed.and pIdOed
on file with The IDAHO BUREAU OF VITA FIEGORDS ANO:IgALT
EATH
St6t8AIeNo 201-2-01065