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AFFIDAVIT OF SURVIVORSHIP
STATE OF UTAH )
) ss
COUNTY OF SALT LAKE )
~,OOK 53~PRPAGE 448
LII,~u~'~ O, OUNTY CLcm~
STEVE A. KUSABA, being first duly sworn upon his oath, deposes and states as
follows:
1. On or about the day 27t~ of June, 1995, my father, TAKAHARU KUSABA,
died, as is evidenced by the official certificate of death attached hereto and incorporated
herein by this reference.
2. At the time of his death the decedent jointly owned certain real property with
· my mother, LOUISE L. KUSABA, said property being located in the County of Lincoln, State
of Wyoming, and more particularly described as follows:
The Lot numbered Eight (8) of the Block numbered Two (2) of the Sunset
Subdivision to the Town of Kemmerer, Lin.coin
surveyed, platted and recorded, together with
appurtenances thereto.
County, Wyoming, as
all improvements and
3. The real. property desCribed above was originally conveyed to TAKAHARU
KUSABA and LOUISE L. KUSABA, husband and wife, as tenants by the entireties and not
as tenants in common, by Warranty Deed dated September 30, i'968, and recorded in the
Office of the Lincoln County Clerk and Ex-Officio Register of Deeds on December 3, 1971,
in Book 96 PR, at Page 414.
449
4, By reason of TAKAHARU KUSABA'S death, LOUISE L. KUSABA was entitled
to sole ownership of the real property described above, the decedent's interest in said real
property having termir)ated and title to said real property having vested absolutely and
continuously in LOUISE L. KUSABA since the death of the decedent. DATED this /~day of -~'~¢'-¢'~ /:)'bY" ,2003.
STEVE A. KUSABA
SUBSCRIBED AND SWORN to and acknowledged before me this
~/f') ~8~ , 2003, by Steve A. Kusaba.
WITNESS my hand and official seal.
My Commission Expires:
o(/t~ry Public
STATE OF UTAH
My Commission Expires
October 1, 2003
MICHAEL R RED[IISH
50 Nodh M~dical Ddve
Salt Lake C~,~
2
This is a tru~' and exact reproduction of the document on file in
the.office of Vital Records-Services, Cheyenne, Wyo,r~ing.,..:
' ;:-=' 4 5 0
Deputy State Registrar
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This copy is not valid unless it bearsa rinsed' seal an~' "'s ..... produced" ' ' ....... on
multicolored,~ecurity paper. '; :-: ~:'" ~ "':-";'" - '- '-
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'~'_S9.~I~ ~ip~B County M~dic~l C~nt~r J ~mm~r~r Un
'~ ':~~- '1 Lincoln I Kemmerer . I~0z Beech
~e 28, 1995
Crandall Funeral Home
Kusaba . Nakako ' ?,r',~ ;i;'Kirloshita
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' I Wife: ,. ,~.'...., .'.. ,' .; .,. ~¢ ,.,. : '; ...' '":..:
Kemmerer ' :~¥ 83'101"':"':'"";'"':' ','"'"'" ...... ":
Lake Mausoleum/gremato
28-.' ~!Kemmerer W,
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