HomeMy WebLinkAbout978251DISTRICT OF COLUMBIA
Thomas Keating Holland, Jr. of 510 G Street SE, Washington, DC 20003, upon his oath
deposes and says:
1. That his mother, SABINA V. T. HOLLAND, the decedent mentioned in the attached
certified copy of Death Certification, is the same person as SABINA V. T. HOLLAND named as
one of the grantees in that certain Warranty Deed dated the 8th day of November, 1983, executed
by Leisure Valley, Inc., grantor, and recorded December 1, 1983, in Book 208 PR, page 54, of the
Official Records of Lincoln County, Wyoming, covering the following described real property
located in Lincoln County, Wyoming, to -wit:
Lot One Hundred Fifty -Six (156) in Star Valley Ranch Plat Five (5) as platted and
recorded in the official records of Lincoln county, Wyoming.
2. That Thomas Keating Holland, named as one of the grantees in the above
described Warranty Deed, and SABINA V. T. HOLLAND were husband and wife at the time of the
execution and recording of the Warranty Deed described above, and that as the surviving
cotenant and spouse of SABINA V. T. HOLLAND, named in said conveyance, Thomas Keating
Holland became on December 15, 2012, the date of the death of the aforementioned decedent,
the owner of the lands or the owner of any interest of SABINA V. T. HOLLAND, in the lands
described in the foregoing, subject to any then existing liens and encumbrances.
DATED the 7 day of
ao-mie
978251 9/4/2014 9:37 AM
LINCOLN COUNTY FEES: $18.00 PAGE 1 OF 3
BOOK: 839 PAGE: 12 AFFIDAVIT
JEANNE WAGNER, LINCOLN COUNTY CLERK
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AFFIDAVIT OF SURVIVORSHIP
4-eati
1
2014.
omas Keating Holland, Jr.
x /Aims
Subscribe and sworn to by Thomas Keating Holland, Jr., before me this
2014.
Witness my hand and official seal.
,y t ommission expires:
BETTY C. WANG
Notary Public, District of Columbia
My Commission Expiree inn 14, 2015
2
NOTARY PUBLIC
day of
N sGREENVIL.LE, DELAWARE.,,
1VI OGRAPHIC INFORMATION:
SID 20 SOU TRAIL, WILMINGTON, NEW CASTLE-COUNTY; DELAWARE 19810
SCE OF BIRTH:. DELAWARE MARITAL STATUS MARRIED
2 V E'SPOUSE'S K
NAME THOMAS HOLLAND
I�N
CTER'SNAME WALTER TRZUSKOWSKI
TRE. vs:N1TE PRIOR TO FIRST. MARRIAGE FRANCES CENDROWS
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Alps A- i; p 4 pot. f 4)� f 4ti •A .cc.
This is to certify that this is a true and correct
reproduction or abstract of the official record:filed
with the Delaware Division of Public Health.'
Any alteration of this document is prohibited Do not
accept unless' on security paper with the' raised "seal'of
the Office of .Vital t
al S atistics.
.Ami r t mit ati� pt s a y Tr r 4ir
egir'e 77
TAL RECORD
STATE FILE NUMBER
CEDENT'S INFORMATION: 107 -12- 007710
ME SA BINA: V T HOLLAND
A's NO LISTED
C F EMALE SOCIAL SECURITY NUMBER:
T E OFrDEATH DEC '15 2012 DATE, OF BIRTH: DEC 05 1925
ACE OF DEATH INFORMATION:
PE H OSPITAL- INPATIENT
CILITY N AMEAND ADDRESS: ..CCHS- WILMIN.GTONHOSPITAL,
POSITION INFORMATION
,TTIOD BURIAL PLACE: ST JOSEPH ON THE BRANDYWINE CEMETERY
;0'1'
NFORMANT'S INFORMATION
INF ORMANT'S NAME: THOMAS KHOLLAND JR RELATIONSHIP FAMILY MEMBER.
INC ADDRESS: 510 G STREET SE, WASHINGTON, DISTRICT O F C O L UM B IA, 20003
L HOME DOHERTY FUNERAL HOMES, INO 1900 DELAWARE AVE WILMINGTON, NEW CASTLE'COUN.T
DELAWARE 19806
GILLIS
,ICENSEN
UNR UMBER K1- 0000527
EASL DIRECTOR: CHRISTIAN A L
SE :OF DEATH:; -:PART I
IE TASTATIC.CARCINOMA
T II
C ONTACTED2 NO AUTOPSY PERFORMED? 'NO .AUTOPSY AVAILABLE?,
17 A1;''ORPRESUMED TIME OF DEATH: 21:19 MANNER DEATH NATURAL
tY $1 FORMATION:
OF INJURY TIME ()F INJURY INJURY AT WO
E O F•INJURY:
TION OF`INJURY.
THE INJURY; OCCURRED?
'IFIER NAME AND TITLE AZHAR H. KHAN MD LICENSE NUMBER C1 0005149
TIFIER'S ADDRESS:. 111 CONTINENTAL DRIVE SUITE 406, NEWARK, NEW CASTLE-COUNTY DELAWARE, 19713'
CE FILED: DEC`20 2012
r OF ISSUANCES SEP 2$ 2013
CIAL INSTRUCTIONS