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HomeMy WebLinkAbout88698604017070 STATE OF UTAH COUNTY OF BOOK .._e~_ ir}?~ PR PAGE RECEIVED LiHCOLH COIJHTY CLERK I, Richard B. Hall, being first duly sworn on oath, depose and say: That I am a citizen of the United States of America over the age of 21 years, and a reSident of Salt Lake City, Utah. That I was well and personally acquainted with Owen H. Hall in that certain Warranty Deed dated April 6, 1977 and recorded April 19, 1983 in Book 200 P.R. at Page 90 as Filing No. 595598 in the office of the Recorder of Lincoln County, Wyoming. That I know of my own knowledge that Owen H. Hall in the said deed and James Owen Hill Hall mentioned in the attached Certified Copy of Certificate of Death was one and the same person. This Affidavit is intended to terminate the joint tenancy (the life estate) of said Owen H. Hall in the following described property: Lot Numbered 27 in Leon Livingston Subdivision in Township 37 North, Range 118 West, 6th P.M. Lincoln County, Wyoming said Plat of said Subdivision, as recorded in the County of Lincoln, State of Wyoming. Subscribed and sworn to before me this B. Hall. Residing in: Commission expires: Richard B. Hall day NOTARY PUBLIC NORMA JANKO 1594 W. No. Temple, Ste. 220 Salt Lake City, UT 84114-6300 My Commission Expires February 12, 2004 STATE OF UTAtI .B ,200,Z, by Richard Notary Public 03~176'-* DEPARTMENT OF HEALTH CATE OF DEATH __ Ja_m_e~2_ 6wen" :HL~'~';T.;i':::,ii::ii;i~L~;. ' IMale May 30, 2002 0115 : · 4, DATE OF BIRTH (Mo., Oay, Yr) ' : S,:,AG,E ~[a~t~!~y ~ 6. BIRTHPLACE C y & S ate ~ Fo~ign Coun ~) 7 SOC ~ SECUR ~ NUMBER ~??,.:;~;_~w~ I ; Wellsville, U~ 528-22-5679 · i . (.~u~ ~ ~ ~M.~); ]A[~ 01~ER ~QC~TIQNS: Bb. N~E OF HOSPITAL, NURS NG HOME OR OTHER FAC L ~ 8c. ClR, TO~. OR LOCATIO~ ~F~TU.~': %~:;;~.~,;:,3 ~ .;~pU~:oF DEATH g. SURVNING SPOUSE (if~N gl .... (d ...... ) , ~llville :' ,;?u%'=~'; '~,~ "~e~ Flor~ - --- ' ' DECEDENT 0 ' ' :;' '; ';" ¢' ~ ce A~es ~ln ARMEOFOR~S? ~l, NeverMa~ied.;:~x~,~&d?l : ...~ g e ~NuTen~ermhr~) .:.. 13e'[~IDECI~i13f'ZIPCODEs::J14:WASDEC~EN~Q~H~S~ANICORIGIN? ~ 1. yes ~ No 15 ~CE-Ba~ ~ite ~ 16. EDUCATlON(s~onlyhighe~ -- . Jo~. P. stev~on ~/~,: 104702 ~ 100681 AT.T,~-~ ~R~Y' 3 PART~ .... ;~ ~ June 3. 2~02 ] ~Ttlne 4. 2002 OR RESPI~TORY ARREST, SHOC~ OR H~ FAILURE L ST ONLY ONE CAUSE ON ~CH L NE , ~x/ -- e~al moeamj ' :' - '.DUETO OR~ACONSEQ~ENCEOff S~uentially list ~ndiBons, i¢ PERFORMED7 FINDINGS AVAI~ LE TO COMPLETION ~'~NNEROFD~TH , ,{ 3~a:DA~E~[~U~Y(Mo.,'Da~ Yr) 3~.TIMEOF NJURY 35c NJURYAT~RK?I35d P~CEOF NJURY ~ ¢~m ~ ' ' This is to certify that this is a true cop~, of:the' cei'tifi6~t~;~n file in this office. This certif ed copy is issued under authority of section 26-2-22 0f(t~e:Utah:obde:Ann6tated 1953 As Amended County R VE .E, ': ':~-;:?.!.:'BafrY E. 'Nangle ' :! ;:'""~::';E~i~TOR OF VITAL RECORDS Registrar By * 0 0 8 9 3 4 0 3 *