HomeMy WebLinkAbout978912After Recording Please Return to:
Peck Hadfield Baxter Moore
399 North Main, Suite 300
Logan, Utah 84321
STATE OF UTAH
County of Cache
ss.
978912 10/20/2014 12:02 PM
LINCOLN COUNTY FEES: $18.00 PAGE
BOOK: 841 PAGE: 621 AFFIDAVIT
WAGNER LINCOLN COUNTY CLERK
1111111111011111111111111114111111111 1111111111111111111111111
AFFIDAVIT OF SURVIVORSHIP
SHIRLEY A. MCBRIDE being first duly sworn on oath, deposes and says:
1. OF
3
1. She is a resident of Malad City, Idaho, over the age of 21 years, and is competent
by personal knowledge to state and swear to the things hereinafter stated.
WRIGHT
2. She is the widow of REED MCBRIDE, who is the named Decedent in the
Utah Certificate of Death, a certified copy of which is attached hereto and by reference made a
part hereof, and knows of his own knowledge that:
WRt6NT
a. The Decedent, REED W- MCBRIDE, named in the said Certificate of
Death, is one and the same person as REED W. MCBRIDE named as one of the grantees
in that certain Warranty Deed dated December 1, 1988 and recorded on January 31, 1989
as Entry No. 698311 in Book 270PR, at Page 295, in the office of the Lincoln County
Recorder, wherein the said Decedent herein is a grantee with SHIRLEY A. MCBRIDE.
3. This Affidavit is made for the purpose of terminating the joint tenancy in its
entirety as to the interest of REED W. MCBRIDE in and to the following described real property
located in Lincoln County, Wyoming:
Lot Fifty -Four (54) in Unit Two (2)
PRATER CANYON ESTATES,
Lincoln County, Wyoming
DATED this 7th day of October 2014.
Page 1 of 2
STATE OF UTAH
County of Cache
On the 7th day of October 2014 personally appeared before me SHIRLEY A.
MCBRIDE, the signer of the within instrument, who duly acknowledged to me that she executed
the same.
ss
NOTARY PUBLIC
JODEL CRANNEY
My Commission 672387
My Commission Expires
November 20, 2017
STATE OF UTAH
Page 2 of 2
11 EMS 33 -3a
TO SE USED
705 E%TE5NA
UAUSES OSLO
(2050 5010)
1.DECEOENTS LEGAL NAME (Include AKA's1Hany) (FIroL.Mlddle ;Last, Su9br)
REED WRIGHT MCBRIDE
4e.AGE.Ieetoirthday 4b,UNDER'1.YEA
Man NiT:Deye::.'
8ESOENCE ATATE OR FOREIGN:COUN
•Merited •q:Meidei5bulsepaial'ed Wldowa5 Q'4Worcn(t•;t] NQy9r lrtep1 )1 I] 0001000
EVERIN IJ.S 11 e.F}TI(ER'S: i1PME (RA
700050.?: ;;GRARL'•ES' MCBRID
�•0 Yos.;,:'_�; 125 10R'S MAIDEN NAMEFiNI;..MIddle, Last'.SUltpr; s•:
"a LuLA vALORA wRicrr
IO.INFORMANTS NAME(Typaor pant' 130. RELATIONSHIP TO DECEDENT
SNI.RG X,MCBRIDE :7: WIFE
,±•:a•14• METNODdl•0ISPOSlT10N':;;: jb: PLACB: OF .OISPOSINOfT:(Nameliid:ad'diess of cemetery, AND COMPLETE, ADDRESS OF FUNERAL FACILITY
Burial C,Omag c...TIgry, olhe pisee),:
Rtidllnon EnlomhmenL HY.RUM CITY.CEMETERY H ORSLEYFUNERAL HOM
8: ❑11'ejedyafii "Idaho 550:EASTMAINSTREET::::� 132WEST3OD ;NORTH
O
HYACIIIIV UTAH .A4319 MALApO.ITY tPAHO83252
14. SIGNATURE OF FUNERAL SERVICE LICENSEEOR PERSON ACTING. ASSIICH:':' 17h. LICENEENUMBER (0flloensee. 19- AS CORONER CONTACTED
DUE TO;OA115EOV'JIEATH?
O ELECTRONICALLY FILED: BRAD C. HORSLEY I M71i'
PLACE OF DEATH
(1922)
::•.•190. IF DEATH•D.000RREE.IN A HOSPITAL: 1el((IF DEATJJACC.URRED SOMEWHERE OTHER THAN A HOSPITAL:
Icefadlfy'5:0N InghomejLong teml 7�] Other (Specl
C 22. RY,TOWN ORLOCAT .0.TH,AND .LP
CQOE;•;( :5 2 COUW.OF DEATH
ONEIUA
27. CAUSE OF DEATH
:.i:iPARL} Enter J(zh(ti� events: dlseases;.ikaa.as�or mmpacallons- lhattlimelly caused the death. DO NOT enter terminal events such as cardiac
.e ii 4. dij ?ades(.acxentrhulerliibditatlaR. Elthap OM eill Y., DO NEMABBREVIATE,.Enter anly.cm, cause on a In
1 or (thrial
dt+easemndejan a YO
tNC,Jt DIAL. (NFARCTIO
-7.: su10 In death T• ":DUE YO'dtas a cone aeara
(lenuallylfe(�Eciidi1dde,•::il
2 ,IYeny. leading (vlhe+daase
astod on Ilse a. Enter the
UNDERLYING CAUSE
LAST ((disease or Injury c
v •Jhal Int toted the e4enls DUE TO (ores 0 cansequance
•.sy:.wsu In deaUi):•'r':i
(:;::PART II. Enter ph& slonahenl 09111lons w Wipe la' death In ha unde
S D g dYNg caQ4RPive
HISTOM P HYP.ERTEASIOnF:_'f:'
.29. DID TOBACCGpGSE
CONTRIBUTETO.DEATH7
n, ❑Yes Probably
E
ia:7FREMAL$:(Aged 1044):
••:7•7,1 ot prognanlw11h1p paslyaai:,,:[T Not prel:hook fN (510 nt 4,3
Q PregnaVINI time ofBealF.i''' 101 year betdra•d'ee11,
0 Not pregnenL but pregnant 0 Unknown It pregeantwithin 11411
wlNn 42 days of death year
TIME.P.F. yfi
A. )JRY 34 PLACE OF INJURY (Decedent's home, f street. consuu slle r'r ,ulu umInDhA surastauran) foresI.et1.)
A'IV,•in orCoun
U rci::: °i >`ii:: ;Apailinenl N f4
37. DESCRIBE HOW INJURY OCCURRED. IF TRANSPORTATION INJURY, STATMTNE9YPES(S) OF VEI)IGI,E(5)1NVOLV5P.(AutBy gills, pakbp., motdilych, ATV'Slcycle, ate.)
SPECIFY WHICH VEHICLE DECEDENT OCCUPIED, U applicable
764011NTY ::,i
ONEIDA,
'2d'.TOI11E•'.DFDEATH (2401)
EODmaled 09:30- 01:30
•x'10Thisocopy not valid unless prepared.o,n engraved'border
?::?aispia;ying seal:ariti'slgryature of the. Reg
emvrmw rmn,m worpwn, so,wocosa'_ Locel:Rei7 N o is:
Cqhums, a n he brier na0on andtorinves0ge0an, h ray-0)30,1°n. death 'peptised al the,gjii dale; 9ii(f pf9c9;ACd due to the Deus
THE COeoNFR_ end manner staled.
SIgeaiore.¢54 of Certifier ELECTRONICALL SIGNED: BRAD .HORSLEY
cA .tETeaiie t
":SJQNT113iS:� "2 .NAME S, AND LP D0Uh OF_CENT(FlEY(Yan
ypr pant):..
11FI
This Is a true and correat.reproduction of the document officially' registered and place
on file witf je IAAHQ :p.1 O jTAL:R.EGORDS ?AND HEALTH STATISTICS.
O.BIRTHPLACE(City e C Stele. Territory. or Foreign Country)
.f(YRUM, UTAH i
MN"
:}64s 131 No
e.SURViVINO SPOUSE'S NAME (If wlto, gNe maldennamej
SHIRLEY ANNE WESTLEY
11b;BJRTHPLACE (Stele, 'oratory, or Foreign County)
12b B)RTHP,LACE(Sta)e, Temtory, orFaoelgn County)
;;UTAH
i30. MAILING ADDRESS :(Street end Ndmjler;:Ciry';•Slela; fitode).,::;..
2511'S. OLD HWY 191 MAULD'CITY,16'83252`
VO, 5V4' Yv
a.-.,, .HMV.. .ry S� SV
y CERTIFICATION OF VITAL RECORD
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