HomeMy WebLinkAbout892087 RECEIVED
AFFIDAVIT
OF
SURViVO~S~cOLN~ul~ COUNTY CLERK
KINGDOM OF SWEDBN
pApISH ~F.,.,, r'l/"/l~/ll/VDi//"~
CITY OF ~T~F"N'U~LM
B92087
SS.
5 '9 PR P^G .
0,3,.111! 31 f~Hll:
KINGDONi OF ~;WEDEN
CITY 0 F,j .8'j'_ .~-~LI~, A 6 N ~
~T~D STATES OF AMERICA
I, Ruth Ingeg2rd SeinegArd, being of legal age and first duly sworn,
depose and say as follows:
1. That Rena Caroline Sundgren, the decedent mentioned in the attached certified copy
of the certificate of death, is the same person as Rena Sundgren named as one of the
parties in that certain County Commissioners' Deed dated January 8, 1958, executed
by Ted Kirkwood, E. T. Brady and Ben Nield, Commissioners to Pete Sundgren and
Rena Sundgren, husband and wife, recorded as Instrument Number 332240, on
January 9, 1958, in Book 26PR at Page 33, of the Official Records of Lincoln County,
State of Wyoming, concerning the real property situated in the County of Lincoln, State
of Wyoming and described as follows:
Lots #1, 2, 3 and 4 of Block "B" in the Riverview Addition
to the Town of Tulsa, now LaBarge, Wyoming.
That Rena Caroline Sundgren, the deCedent mentioned in the attached certified copy
of the certificate of death, is the same person as Rena Sundgren named as one of the
parties in that certain Certificate of Title for Motor Vehicle, No. 12-70105, dated July
26, 1973, recorded on July 26,. 1973 in Book 67, Page 70105 of the records of the
Office of the Lincoln County Clerk, Lincoln County, State of Wyoming and described
as follows:
',i.197.3,Magnolia Mobile Home, VIN # GC-M-FF-H-M-N-7956,
· ':M°del 6614.
That I am the niece of Rena Sundgren and thereby am a person interested in the
effective property or the title thereto and pursuant to § 2-9-102 W.S. (1980) hereby
make the death a matter of record and certify that upOn the death of Rena Sundgren,
her previous estate in the property was terminated.
That the 'certified copy of the certificate of death indicates that Rena caroline
Sundgren died on the 12th day of April, 1999 in the City of Jackson, County of Teton,
State of Wyoming.
Dated this 17th day' of July, 2003.
RUTH INGEG~EINEGARD
1
-K-t,NGD(DM ~ O~A/r-~--kl
pADIOI I thE'
~1 \1~,..~1 I %,.,,~1 I.-~.,..~lVll\ I
CITY OF STOCKHOLM
SS.
015
KINGDOM OF SWEDEN '1
CITY OF STOCKHOLM
EMBASSY OF THE SS:
,_:,':rED STATES OF AMERICA
GO.NSIg-L-A-TE G-E-NE-RAL OF T,,~- , ,M,T,-r~ (:;:T^TI:c:: (hi:' AI~/II::DIP^ AT
qTt"lPIZ'Plt'hl M SW-EDE-N-
MarJut H. Robinson
~,~ the undersigned (Name
of Officery,'COnsul ~ of the United States of America at the City of
Stockholm, Sweden do hereby certify that on this 17th day of July, 2003, before
me personally appeared RUTH INGEGARD SEINEGARD, to me Personally
known and known to me to be the individual described in, whose name is
subscribed to, and who executed the Affidavit Of Survivorship which is the
instrument annexed hereto, be duly acknowledged to me that she executed the
same freely and voluntarily for the uses and purposes therein mentioned.
In witness whereof, I have hereunto set my hand and affixed the seal
of the United States Consulate at the City of Stockholm, Sweden, the day and
(Signature/ · '
(Name & Title)
year first above written.
Marjut H. Robinson
Vice Consul of the United States
of An!edca.
5:':
2
, ,.
STATE OF WYOMING
FOR
INSIRUC'nON$
SEE
LOCAL FILE N~IUSER 99O3.7
DEPARTMENT OF HEALTH
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
CAROLINE
4. SCX;iAL SECURITY MJMBEI;
520~05~980.$
HANDBOOK
VR 2-89
8/97 15M
AUGUST ............ :: ' RAVENELLi~!:
BERDE['~ JACOBSEN
LaBARGE
::CREMATION
FOX · CRF~TORY R~ SPRINGS WYOMING
HUDSON'S ,.~ HOME 115 164.. N. BRIDGER AVF2q-[JE
220 .J^¢IqSON ':' WYO 83003.
08'2 7:::87
This is a true and exact reproduction of the docuh~ent on file in the office of Vital
R,cords Services Cheyenn,, Wyom ng
Deou~ State Regm~ar
popy is not v~id unless prepped on paper ~th ~ engraved border d ~-- a e, sea 8nd s gnature of thc Deputy State ~eg s tar.