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PAGE
STATE OF WYOMING )
) ss
COUNTY OF PARK )
8942
JAY W.~ BROWN being of lawful age and first duly sworn on oath according to law,
deposes and says:
1. That I am the surviving husband of Patricia I. Brown.
2. That by virtue of that certain Quitclaim Deed executed May 28, 1994, given by
Bobby Jack Thompson and Wilma Sue Thompson, title to an undivided one-half interest to the
real property first hereinafter described was vested to Jay W. Brown and Patricia I. Brown,
husband and wife with right of survivorship as tenants by the emireties, and said Quitclaim Deed
was subsequently recorded on the August 2, 1994, as Instrumem Number 787498, in Book
355PR at page 105, in the records of the County Clerk of Lincoln County, Wyoming, and that a
description of said property is as follows, to-wit:
LOT THIRTY-FOUR (34) in STAR VALLEY RANCH PLAT TWENTY-ONE (21) as
platted and recorded in the Official Records of Lincoln County, Wyoming.
3. That affiant certifies that Patricia I. Brown, a/k/a Patricia Anne Ingram Brown,
died in Cody, Park County, Wyoming, on July 18, 1999, and a coPy of the official Certificate of
Death of said decedem certified to by the public authority in which state such original CertifiCate
of Death is a matter of record is hereto attached and hereby made a part of this Affidavit.
4. That this Affidavit is made for the purpose of making a matter of record the
termination of the previous estate in said property of Patricia I. Brown and establishing the
survivorship of Jay W. Brown.
DATED this 22nd day of September, 2003
STATE OF WYOMING )
) ss
COUNTY OF PARK )
The foregoing instrument was acknowledged before me by Jay W. Brown this 22'~ day of
September, 2003.
Witness my hand and official seal.
My Commission expires:
Notary Public
INS111~NS
SEE
PATR I CIA
091-24-2503
STATE OF WYOMING.
HANDBOOK
DEPARTMENT OF HEAbTH
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
ANNE .,,.,~'~,, ¥~ ~.u,,~., . ,.,,,, ,~o,:.,~.r,~. ~". ',,,.,'.
'~ ~"~f'~" .... BROWN . ::I.i~,E~AL.E I J~LY::18{"'1999
Dy' :':
180.7 14TH STREET -:~ .... :;:~ ? ? P RK :'
NEW YORK ...... ~;g.~.,. MARRIED :., ~AY ~. BROWN ..;~, .
:~; ' -:'~:: ' d ~N,, ~ ~ ~) .:'. ~ 4' ~:~::. ! ~'; ' ' :~.
I TEACHER' "' "..',-,.,47E~CATION
WYOMING ~:. ~ PARK ~OD,
zBO/ I4TH J~REE~
YES ~: ~ ;~;':~,~, ;WHI:~E~:' .::.
HAROLD I NGRAM: ,: ::. :'~' -. ,CATHERINE'],.,....~*-.o..,.~o,~c~.s.~:HUsBAN:'::::ED .....
Fi'II
ALFRED
JAY W. BROWN
VR 2-8g
8/97 15M
1807 14TH STREET CODY WYOMING .... 82414
RIVERSIDE
ERAL HOME
':: ...... ' CODY WYOMING '"i:
75 636 19TH ST. WYO
M
STEPHEN E. MAININI~, M.D. 721 SHERIDAN AVENUE CODY,
WYOMING
82414
::.:': .~" ':-:'::ii ~' ?!: "!::::i~: ......
{,] .... ~X~:L7 ~/' ~'~c'~ :.,.
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This iS a true and exact reproductioii 0f the dcicument on file in the office of Vital
Records Services, Cheyenr]e, wyoming.
DATE :ISSUED: 'JUL 3:0
Deputy State Re~l~irar
: ~i~S copy is not ~Mid unless prepared on paper with aa engraved border displavina the dale, Seal and Signature Orlhe Deputy S~ate RegistYmr.