HomeMy WebLinkAbout888009THE STATE OF WYOMING
THE COUNTY OF LINCOLN
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) SS.
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RECEIVED
:LIN.C,O...b.! OOL!NTY OLERK
888009
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AFFIDAVIT TERMINATING ESTATE BY THE ENTIFIETIES
BOOK_ S!__~_~PR PAGE
I, L. Ross JenSen, being of lawful age and first duly sworn according to law,
upon my oath, depose and state:
That I am of adult age, a resident of Pocatello, Idaho, and the Affiant
herein.
That by virtue of the conveyance which is recorded in the office of the
County Clerk for Lincoln County, Wyoming, located at Kemmerer,
Wyoming in Book 335PR on page 640 is recorded a Warranty Deed. The
Warranty Deed, dated the lOth day of September, 1993 conveys unto
L. Ross Jensen and Beverley R. Jensen, Husband and Wife as Tenants
by the Entireties the following described property, to-wit:
Lot 29 of Star Valley Ranch Plat 12, Lincoln County, Wyoming as
described on the official plat thereof.
That said Beverley R. Jensen died on the 4th day of February, 2003, and
a copy of the original certificate of death, certified to as true an correct
by public authority in which the original of said certificate is a matter of
record, is attached hereto as Exhibit "A".
That by reason of death of said Beverley R. Jensen and by reason of §2-
9-102 W.S. (1980), the decedents interest and title in said conveyance
has terminated and title to the real property conveyed thereby has vested
absolutely in L. Ross Jensen continuously since the death of the said
decedent.
FURTHER AFFIANT SAYETH NOT.
Dated:
~" L. Ross Jensen
State of Wyoming
County of Lincoln
this
The foregoing instrument was subscribed and sworn to me by L. Ross JenSen
21 day of February, 2003.
Witness my hand and official seal.
My Commission Expires:
November 4, 2006
- N~ Public
DateFiled..FEBRUARY 1.~,. ]3
k[YH ANI~'w
VITAL ST
00891
BEVERLEY LAVERN-ANN JENSEN .... .... 7 ..... ..... __ 2 .....
S~ : ...... - 4-'] L.__~ - $~L SECUC~'Y NUMS~ __ AGE - . . J ~TE ~ BImH
FE L :~ : 5'19-28-~22--' -7~ YEARS:'-/ 31,
I
BLACKFi00T:, .IDAHO~''
MARRIED
OCTOBER
!L~=L:FL-]'~F'i'"-- J P~ACE~t~E,.-POCATELLO~ IDAHO---''
I~ bLOYD ROSS JENSEN
· WAS DECEDENT EVER IN
U.S. ARMED FORCES?
NO
N~ME
WILLIAM E. RUSH
MOTHER - MALDEN NAME
VIOLA SUSAN NEIDER
BURIAL
POCATELLO, IDAHO
FEB; 04, 200]J BANNoc'K:'i'~''7'- '
CAUSE OF DEATH (undeF!ying cau~ las~ ........
METASTATIC .BREAST :r, CAN~ER
:yEXRsii _:
- DUE TO (or ss a.cap~quqp~e of): .. :~:,:% :~-:=:. ,_:=~ ...... · -:.- ...............
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING'TO-DEATH bu not resulang n
NONE STATED
WAS AN AUTOPSY
' NO
PERFORMED?
TITLE . ~,,, /".
CORONER SUFISEOUENT CERTIFICATION IF NECE'~$ARY,'
BATE OF INJURY
a true
_ .~..~_6n:.file with the IE
¢ registered ar~ ~l&cea , ,~
EALT_H POEICY ~ND VI~AL STATlSTIOS.'_--"-__
t on engraved border ~, - :'". ' I~E S. SMITH
qeEe0istrar~ ~ ': . .... ~TA~GiST~R