HomeMy WebLinkAbout978464In the Matter of the Estate of:
VERNON W. STILSON,
Deceased.
STATE OF WYOMING
County of Lincoln
STATE OF WYOMING
County Of Teton
SS
ss.
Witness my hand and official seal.
Scutt D. Wearer -N Iig
SEAL]
County of r i Sate oT
Teton Wyoming
Commission Expires Jul 5.2016
AFFIDAVIT OF SURVIVORSHIP
PURSUANT TO W.S. 2 -9 -102
978464 9/19/2014 11:54 AM
LINCOLN COUNTY FEES: $15.00 PAGE 1 OF 2
BOOK: 839 PAGE: 775 AFFIDAVIT
JEANNE WAGNER LINCOLN COUNTY CLERK
1111 III IIII IIII I II I II II III
William E. Stilson
111111111111111
I, William E. Stilson, being first duly sworn, do hereby state as follows:
1) I am an adult, competent to testify, and make the following affirmations based
upon my own best investigation, information and beliefs;
2) I am an interested person and make this Affidavit pursuant to WS 2 -9 -102;
3) This affidavit relates to the following described parcel of real property situate in
the County of Lincoln, and State of Wyoming, more particularly described as
follows, and hereinafter referred to as the "Subject Property
Lot 11 of the Blue Lake Estates Subdivision, Lincoln County, Wyoming,
according to that plat recorded November 13, 1991, as Instrument No. 740865 in
the Office of the County Clerk.
Subject to reservations and restrictions contained in the United States Patent and
to easements and rights -of -way of record or in use.
Together with all improvements and appurtenances thereon.
4) The Subject Property was conveyed to Vernon W. Stilson and L. Jeannine Stilson,
husband and wife, as tenants by the entireties, Grantees, from Vernon W. Stilson
and L. Jeannine Stilson, Trustees, or their successors in Trust, under the Stilson
Living Trust, dated January 24, 1995 and any amendments thereto, Grantors,
Grantor, via that certain Quit Claim Deed recorded in the Office of the Lincoln
County Clerk, Lincoln County, Wyoming, as document number 87382, in Book
457 of Page 317 on or about December 21, 2000;
5) That Vernon W. Stilson died on December 12, 2004, and the place of last
residence of Vernon W. Stilson was the County of Lincoln, State of Wyoming.
See Attached Death Certificate;
6) Decedent, Vernon W. Stilson, was the same party who was named in and whose
death terminated the previous estate in the property under the aforementioned
Quit Claim Deed, and following the death of Vernon W. Stilson, L. Jeannine
Stilson is the sole interest holder in the Subject Property.
FURTHER AFFIANT SAYETH NAUGHT.
Dated this 13 day of September, 2014.
The foregoing Affidavit of Survivorship Pursuant to W.S. 2 -9 -102, was subscribed, sworn to
and acknowledged before me by William E. Stilson, Affiant, on this 9 day of September,
2014.
cAl
Notary Public for the State of Wyoming
My Commission Expires: I. l a-o (�p
AFFIDAVIT OF SURVIVORSHIP
Page 1 of 1
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16. METHOD,OF DISPOSITION ilI L 1.79 PLACE OF DIt)SRION (Name.I. 1, 176..LOCATION -CIT.YOFITOWN AND STATE
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EM.426' '1'.:' ::''SbI.114T.AE;; MORTIJAitY:' 44 EAST EbViiTU:':-.AVE... AFTON.
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(most, respiratorY'Speit orvhifyiLMIM.Brillation withOuL;sliring 1...tiology.DONOT ABBREVIATE: EMU °dye cauue on a IfieJArld:addiliona Un
EDIATE CAUSE (FinUt disdaSO
'90S51 iSA msdiU01) LDUEToleiras 00l5 00
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leading to the cause listed on line a
Enter the UNDERLYING OAUSE.
.(MsoUso °MAW!) that Inilialed the 'DOB TO (or ass consequence of)
cnieMS rPsultIng)p deathilAST:
3hINAS CORONER CONTACTED?
"*.trfflignIzal7
Om
LOCAL FILE NUMBER
liGECEOENTFLEGA. NAMS:hriblude MARI! any) (Firsl, HMO. last)
VERNON WARREN STILSON
4. SOCIAL SECURITY NUMBER 50. AGE -Last Birthday
(years)
IF DWH OGCORREDaN A HDSPITALP
0 694iien1 OuiPallerd 0 DOA
LO.
Cr 0
0
a) CC
]..1 2 0.WEREAUTOPSYFINDINSAVAILABLET0C0MPLETETHECAUSE0FDEATh? 27. DIGTORACCO USE CONTRIBUTE TO DEATH?
TOT LI:
OYES 1!3'NO III if, L: ;:ii OYES 01410 OPROliABLY
2801F..FES00IS4GE(T)0.54
0 NoiPrognant within past year 0 Not pregnant, but pregnant 43 days to 1 year beton; death Natural
03 0 Pregnant al time of death 0 Unknown 4 pregnant 0111110 110 past year 0 Accident
0 pregnant Githin 42 days of death
'LL
30. DATE OF INdURY(Mo/Day/r) 31. TOE OF INJURY
34. LOCATION OF INJURY (Street and number. Cily or TO Slate)
35. IF TRANSPORTATION ACCIDENT. SPECIFY.
0 Driver Opgrator 0 Pedestrian
cjp essordier 0
95. DESCRISBHOWINJURY 0CCURRED. AND IF TRANSPORTATION INJURY, TRg TYPE(S) OF vgHicL(s)INVOLVEO:(Ahitomobileickap rbotorcyd(0:Afv, blcycld:
370. CERTIFIER (Check only one)
Ig.pffisicIAN :To the beet myknowledge, death...cad dale:anifildece. ihcldtiaTo'Ute causv).nettilunnor:slated.
:CORON 1:1 --On the hams ol examination. aId! or Invoitigatfon. M occuredddi the the, (tali tuiton. Od due ioithe cabseM) ati5 man* stated.
A
Signature of Cavalier
378. DATE CERTIFIED (Mo/Day/Y1)
35 SIG
00
iU
STAT
DEPARTMENT OF HEALTH-
SIVE OF WYOMING
DEPARTMENT OP,IiEALTH
CERTIFICATE OF DEATH
76
SU: UNDER 1 YEAR
Months
Days
32.RLACE OF INJURYpcoodenl.home..Ohslruc1 fin site. Iffiest. olG)
-This Services,
true
and re i o n f g the document on file in the office of Vital
Records
EC 21
bATEA$sUE1):
"Tfirerlfric
AL RECOOL)--:
MALE'.
50,0140010 1 DAT'
Hours, Minutes'
37c NAME. TITLE AND ADDRESS OF CERTIFIER (Type or punt)
ALLEN' CART 4R. 1,19
.3:GATEOF.DEATH (mo/DaYAlj(Spiall Mona))
DECEMBER 124x
6, DATEOF'FIIIITH (Mo/DayNr)
'FEERUARY 13, 1928
-/97-0,-
`7
2 0 0
STATE FILE NUMBER
00190, (SOMA?
7d. COUNTY OF DEATH
1=0= SY
7
.O YES NJ40
CI UNKNOWN
0 Hendee
0 Panding Investigation
..0Coulq notte
33.I5OURY AT WORK?...
0 YES 0 NO
309 DATE RECEIVED BY REGISTRAR (MadpayNdf
feir4...figkatr
NE AFTON WYQMING' -631110
Lucinda McCaffrey
Deputy State Registrar -t
This copy is not valid unless prepared on paper with an engraved border displaying the date, seal tutd signatttre of the Deputy State Registrar.
`,12M72--.211774,2SroT.Ati.T-