HomeMy WebLinkAbout978173I, Marla Maree, being of lawful age and duly sworn according to law, upon my
oath, depose and state:
That under the date of October 13, 2010, for valuable consideration, Marla
Maree, a single woman, by deed of that date, which deed was duly filed of record in the
Office of the Lincoln County Clerk, on October 22, 2010, in Book 755, Page 795,
conveyed to Marla Maree and Thomas C. Chapoose, as joint tenants, the following
described land, in the County of Lincoln, State of Wyoming, to -wit:
That by reason of said conveyance aforesaid, the said Marla Maree and Thomas
C. Chapoose, 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 Thomas C.
Chapoose, also known as Thomas Carnes Chapoose, on the 6th day of February, 2014.
That by reason of and upon the death of Thomas C. Chapoose, title in the above
described real property vested in Marla Maree.
Affiant avers and certifies that Thomas C. Chapoose, also known as Thomas
Carnes Chapoose, is the identical party named with Marla Maree in the aforementioned
deed, whose death terminated his 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.
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Lot 6 of Block 2 of the Amended Plat Brown's 1st Addition to the Town of
LaBarge, Lincoln County, Wyoming as described on the official plat filed
on February 24, 1983 as Instrument No. 592367 of the records of the
Lincoln County Clerk
Dated this j'7 day of
State of 1N I O j f
County of 4-. i.tcsl
IIIIIIII
IIV
1111
II II
Affidavit of Survivorship
/III
s s.
WITNESS my hand and official seal.
My Commission Expires: 6
978173 8/29/2014 10:03 AM
LINCOLN COUNTY FEES: $15.00 PAGE 1 OF 2
BOOK: 838 PAGE: 547 AFFIDAVIT
JEANNE WAGNER, LINCOLN COUNTY CLERK
2014.
County of
Lincoln
Marla Maree
Subscribed and sworn to before me, notary ublic in and for said County and
State, by Marla Maree, this a day of l 2014.
Notary Public
Katherine Lamon Notary Public
State of
Wyoming
My Commission Expires 7/17/16
'Decedent:
N ame:
ender:
ate" Of Birth.
Date and Place of Death
ijafe of Death: February 06, 2014
C Death: La Barge
C;:ti 433 S EIrrr:Street!'
d ditiona Decedent Information
,-t..
444 0s r invemttt;c7ffmsJRCTO.,
„ye— s
I
...4„ RECORD
Othdr.Significant
donditionS:
,Manner of Death:
ettifier:
AmeriennEandrIVot 'Cord
S TATE 0,F MIN
DEPART OF HEALTH
CERTIFICATE DeATH
State File Number:
Thomas Carnes' ChaPcoe
Male
September 12, 1942
VVhiterpcks, Utah.
La Barde, Wyoming
Divorced
No
PreCe'-Of Birth:.
esiderge:
drital.Status:
rifiddForce.s:
4(0e
Name of Mother
I nf�rmant:
position
ethOd. of Disposition:
Id:Ce of1Disposition:
F uneral or FacilJty
immediate cause listed the firstline by Ah. :uhderl}iing.9thqse
0)1171ypOXE MIA
10{..kIGHT .MID LOBE PNEUMONIA
(c) COPD
Wanda MaelaRoSe'
Tracy Chapoose
Social;SeburitY Number:
Age at the Time of Death:
Cremation
!dependant Professional Services,, Salt Lalce CIty, UT..
CHF, IDDM poorly controlled; .C
Natural Death 'Time of Death:
Coroner
Cliff Boyd, Deputy
274N St Box 57 GroVer, WyoMing, 831.22
75853'4.
This is'
a true certification of the document on file in the office of Vital
Statistics Sen.fices;.Cheyenne;Wyoming;
5'1 DATE ISSUED:
Wednesday, March 26, 2014
This copy not:valid.nnleas prepared ep paper with an engraved border
a9.-
....:dames..McSnde
Deputy State kegittrar• 9
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