HomeMy WebLinkAbout891854THE STATE OF WYOMING
COUNTY OF LINCOLN
891851
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PR PAGE
REOEIVED
iL.INOOLN COUNTY OLERi<
AFFIDAVIT TERMINATING ESTATE AS JOINT TENANTS
I, DUANE B. JOHNSTON, being first duly sworn, upon my oath depose and says:
1. That I am of adult age, a resident of Thayne, Wyoming, and the Affiant
herein.
2. By warranty deed dated June 12, 1989, in Book 274PR on Page 465,
Instrument Number 703576, in the office of the Ex-Officio Register of Deeds for Lincoln
County, Wyoming, Leisure Valley, Inc., a Corporation, as Grantor, conveyed unto
Duane B. Johnston and Mary C. Johnston, as joint tenants with rights of survivorship,
the following described property situate in Lincoln County and State of Wyoming, to-wit:
STAR VALLEY RANCH PLAT FIFTEEN (15) LOT FIFTY-EIGHT (58)
as platted and recorded in the Official Records of Lincoln County, Wyoming.
3. Said Mary C. Jolmston died on March 23, 1995, at LDS Hospital,
Salt Lake County, State of Utah, and a copy of the official certificate of her death,
certified to as true and correct by the public authority in which the original of said
certificate is a matter of record, is attached hereto as Exhibit "A".
4. By reason of the death of said Mary C. Johnston, her interest and title
in said warranty deed has terminated and title to the real property conveyed thereby has
vested in Duane B. Johnston, husband of Mary C. Johnston.
FURTHER AFFIANT SAYTH NOT.
Dated this
day of July, 2003.
I~t.J~-~N~ B YJO-HNST0~
THE STATE OF WYOMING
COUNTY OF LINCOLN
SS.
$9O
The foregoing instrument was acknoWledged before me this 10th day of July,
2003, by Duane B. Johnston.
WITNESS my hand and official seal.
NOTARY PUBLIC
My Commission Expires:
SALT LAKE CITY - COUNTY HEALTH DEPARTMENT
O~,~1S~ DIVISION OF VITAL STATISTICS
sTATE oF UTA.- OE. .TME. 8 9 1
.................... CERTIFICATE OF DEATH
LOCAL PIL~: NUMBER , 1 ~- 1 10~ STATE FILE NUMBER
,..^ME OF DECEDENT *;RST .... MIDDLE ~ST~, £~nateSEX ~a.HarchCATE DP o~*~.23, ~.01995Dar. YO
., ~ C~ol~e Jo~st~ 0045
J~e 5, 1938 56 v,~ Ce~r Ci~, Ut~ 530-20-8550
~,npal,ent ~EROulpalien( DOOA D Nursing Homo ~..,,~ .... ~o,.., ~S Hospital
Salt ~e Ci~ Salt ~e ~e Jo~st~
ARMED FORCES? ~ Never Married ~
41 ~p~ Way . ~e] L~co~I
L,U,ts~ 83127 14.WAS DECEDENTOF H'SPANI6 ORIGIN7 ~Yes ~No 15 RACE- Bla~ Wh,e.~.lndian
PARENTS ~ ~i~ ~lstr~~ ~ice D~
INFORMAHT
~e Jo~sCm, husb~d, P 0 B~ 26, Ema, ~ 83118
20. METHOD OF OISPOSIIION 21a. DATE OF DISPOSITION 21o. PLACE OF DISPOSITION (Name otcemele~ 21c, LOCATION - Cdy or loNe, Stale
DEolombmen, DOonallon DOths, ~rch 27, ~scc s mxnoresn
DmsPoSmO. ~su,,.. ~c,,mat~on ~ ..... , 1995 M~al P~k Ogd~, Ut~
~~' //~~ ~91156160902 ~ Leavitt's Chapel of Flowers Mortuary
836-36rh
St~eeE
[I~ yes, artier Ihe dale and hour reposed: M.E. Case ~ ...... [ O~d~ U~ah 8~0~
~- 23 -~ I .... 0200 .o D~r o~, 23 .... 1995 [ ~ '
CERTIFIER 27a. CERTIFIER
~ CERTIFYING PHYSICIAN
To the besl of my knowledge, death occurred al the lime. dale. and place, and due Io Ihe cause(s) and manner as staled.
~ MEDICAL EXAMINER / LAW ENFORCEMENT ~FICIAL
On Ihe basis ~ex~ination~dlor inv~¥n, in my ooinion, dealh Occurred at Ihe time. date, place, a~ due Io the causels) and manner as slaled.
27b. SIGNATUREANO~F~TiFIER/~ (~/ ~ 127c LICENSE"UUBER 127d. OATES{GNED(MO.Day.
St~ Holm, H.D., 32~ 10~ Av~e, Salt ~e C~, ~ 86103
31. PART I ~NTER THE OI5~AS[S~JUR~. OR ~MPLIGATIONS THAT CAUS[~HE DEATH DO NOT ENTER THE MODE OF DYING. SUCH AS CARDIAC Appt~xmmale Inte~al
OR RESPIRATORY ARREST, SHOCK, O~ FAILURE~ L~ST ONLY ONE CAUSE ON EACH LINE. Baleen Oosel And
disease or condition "~-b c~h7 .......................... I ~-
Sequenliallylist conditions. ~.
cause. Emer UNDERLYING
CAUSE (d~sease or iNu~ ~ I
thai initiated events resulting ~uE TO (OR AS A CONSEOUENCE CFI:
I
CAUSE OF in death) ~ST
DEATH
PART II. Olhe~ Sigmh~n( Condmtions conltibullng Io death but nol 32. IN YOUR OPINION. TOBACCO USE BY THE DECEDENT 33a. WAS AN33b. WERE AUTOPSY
AUTOPSY FINDINGS AVAI~LE
D Was Ihe underlying cause ol ~ath OF CAUSE OF DEATH7
~ Suicide ~ Hom~ode ddver, passenger o¢ De~estPen.
This is to certify that this is a true copy of the
Thomas L. er, MD _:. ~ i£-' -'
Director of Health : ~'.' ~- .~
information on file in this office. This certified
copy is issued under authority of Section 26-15-26
of the Utah Code Annotated, 1953 as amended.
Date Issued
MAR :2 Z_ 1995
147883