HomeMy WebLinkAbout978139I, Ray C. Fritz, being of lawful age and duly sworn according to law, upon my
oath, depose and state:
That under the date of November 16, 1999, for valuable consideration, Roger J.
Goodman and Diane K. Goodman, husband and wife, by deed of that date, which deed
was duly filed of record in the Office of the Lincoln County Clerk, on November 18, 1999,
in Book 438PR, Page 465, conveyed to Addaline L. Johnson, Ray C. Fritz and Jacalyn L.
Fritz, as joint tenants, the following described land, in the County of Lincoln, State of
Wyoming, to -wit:
Lot 11 and N1 /2 of Lot 10 of Block 3 of West Valley Subdivision,
Lincoln County, Wyoming as described on the official plat thereof
That by reason of said conveyance aforesaid, the said Addaline L. Johnson, Ray
C. Fritz and Jacalyn L. Fritz, as joint tenants, became the owners of said real property,
and the title thereto vested in them continuously from the date of said conveyance, to the
death of Jacalyn L. Fritz, also known as Jackie Fritz, on the 23rd day of July, 2011 and
the death of Addaline L. Johnson, also known as Addaline LaMyra Johnson, on the 2nd
day of March 2014. That by reason of and upon the deaths of Jackalyn L. Fritz and
Addaline L. Johnson, title in the above described real property vested in Ray C. Fritz.
Affiant avers and certifies that Jackalyn L. Fritz and Addaline L. Johnson, are the
identical parties named with Ray C. Fritz in the aforementioned deed, whose deaths
terminated their interest, title and estate in said real property; and Affiant attaches
hereto, and makes a part of this affidavit, copies of the Official Certificates of Death of
said decedents, duly certified by the public authority in which said death certificates are
a matter of record.
Dated this %Z- 5 day of
State of
County of
ss.
Subscribed and sworn to before me, notary p 1ic in and for said County and
State, by Ray C. Fritz this (9 5 day of (.4v l 2014.
WITNESS my hand and official seal.
978139 8/26/2014 3:28 PM
INCOLN COUNTY FEES: $18.00 PAGE 1 OF 3
IOOK: 838 PAGE: 482 AFFIDAVIT
EANNE WAGNER LINCOLN COUNTY CLERK
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Affidavit of Survivorship
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Other Significant
Conditions:
jManner'Of Death:
Renal Failure
Natural Death .c
STATE QF WYOM I'N
DEPARTMENT OF HEALTH
Cettifier:
'Type: Physician
arrl'e George Krell, M.D.
ddress:. P.O B9x 390, Kemmerer Wyoming 8310 t.,
ate Filed March 13 >;2014
75 98
This is a true certification of the document on file in the office of Vital
Statistics Services; Cheyenne, Wyoming;
;This copy, is notvalid unless prepared on'paperwith'an engraved/border..<:
Cause of Death:.
The immediate cause listed`on the first line followed by any underlying causes Interval
.(a)Congestive Heart Failure Weeks
D ecedent: State File Number: 2014. 000700
ame: «1. Addaline LaMyra Johnson
Oder: Female Social Security Number
Date'of Birth: May 27, 1921 Age at the Time of Death: 92 years
D ate and Place of Death:
Date of Death: 'March County .'of Death:: Lincoln
Cityof Death: Kemmerer
Location: SOUth Lincoln ,Med'fcal Center'P0 Box 390
Additional .'DecedentInformation:
Place of Birth. Lebanon I dian�
Residence La Ba ge, Wyoming
MarltalStatus.`> 'Widowed_
rmedForces: Yes
Name of Father: Harley Hughes
Name: of Mother: Alpha Power:
nformant: LaRae Fritz Relationship: ''Granddaughter
i
M ethod of Disposition: Cremation
tae of Disposltion UFD Cremation Center South Jordan, Utah
nP
uneral Home or Facility,
Fa c ility: Bali Family Chapel, Evanston; Wyeming
Time of Death: 04:39•(Actual)
DATE iS Friday, March 14 James Mc &ide
Deputy State Registrar
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CERTIFICATION
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