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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
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