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STATE OF WYOMING
COUNTY OF LINCOLN
!BOOK ~3';"~.?R PAGE 6 6 0
LINCOLN COUNTY CLERK
03 OCT-8 AHIO: 19
That I am a citizen of the United States of America over the age c, ~ years, and a
, N1N E W A O'N E R
resident of Montpelier, Idaho-~-,",~-q'rp ,',,,- ,-, ....
~ - ' ' [% ~'~" ', ¢;5
That I was well and personally acquainted with Nancy L. Toomer in that cmtain Wan'anty
Deed dated March 14, 1989, Book 277 P.R. at Page 201 in the office of the Recorder of Lincoln
County, Wyoming.
That I lmow of my own knowledge that Nancy L. Toomer in the said deed and
Nancy Lee Bentsen Toomer mentioned in the attached Certified Copy of Certificate of Death
was one and the same person.
This Affidavit is intended to temfinate the joint tenancy (the life estate) of Nancy L.
Toomer in the following described property:
This Afficlavit;'is being re-recorded to correct the legal description.
See Attached Exhibit "A"
Subscribed and sworn to before me this ~C) day of August, 2003.
State of Wyoming-Notary Pl,lbl~
County of Lincoln
................... Notary Public
Residino in'~ '
Co]mnission expires:
H]SALT
COOPERATIVE CENTER FOR 450 W. STATE ST.
HEALTH STATISTICS - VITAL BOISE, IDAHO 83720
°
~3,~.,~,~jL~.~) CERTIFICATE OF DEATH 66 ~
DATE FILED: NOVEMBER 25, 1991 STATE FILE NUMBER: 91-06433
DECEDENT: NANCY LEE BENTSEN TOOMER
DATE OF DEATH: NOV. 19, 1991
DATE OF BIRTH: MAY 03, 1949
AGE: 42 YEARS SEX: FEMALE
MARITAL STATUS: MARRIED
PLACE OF DEATH: MONTPELIER, IDAHO
PLACE OF BIRTH: IDAHO
VETERAN? NO
SURVIVING SPOUSE: ROGER TOOMER
SOCIAL SECURITY NUMBER: 518-68-7782 RESIDENCE: MONTPELIER, IDAHO
FATHER: A. J. BENTSEN
FATHER'S BIRTHPLACE: IDAHO
MOTHER (MAIDEN): PAULINE BARKDULL
MOTHER'S BIRTHPLACE: IDAHO
MORTUARY: MATTHEWS MORTUARY, INC.
MORTICIAN: LEONARD H. MATTHEWS
CERTIFYING PHYSICIAN: LARRY D. BOMSTA, MD
1. CAUSE OF DEATH, UNDERLYING CAUSE LAST:
CARDIAC ARREST
PROBABLE PULMONARY EMBOLISM
METASTATIC BREAST CANCER
MONTPELIER, IDAHO
DISPOSITION: BURIAL
AUTOPSY: NO
INTERVAL
5 MINUTES
15 MINUTES
2. OTHER CONDITIONS CONTRIBUTING TO DEATH BUT UNRELATED TO ABOVE CAUSES:
NONE LISTED
DATE ISSUED: DECEMBER 02, 1991
This is to certO'y that this is a tree and corrvct reproduction or abstract of the official ri, cord
filed with the Idaho Department of Health & Welfare, Boise, Idaho.
RICHARD W. BLAIR, State Registrar
DO NOT ACCEPT UNLESS ON SECURITY PAPER WITH EMBOSSED SEAL OF IDAHO
DEPT HEALTH & CLEARLY AFFIXED.
section 39-273 ldnho Code
HWH0139
662
EXHIBIT "A"
Part of Lot 256 of Lake View Estates Incorporated Tract A, Lincoln County,
Wyoming, and further described as follows: ~
Beginning at the SW corner of said Lot 256, thence N32~00"E, 90 feet in
the west line of said Lot; thence S6417%2'E, 100.00 feet to the east line
of Said Lot; thence 35 35 W, 90 feet; thence N64°12'W in the south line
of said Lot, 100 feet to the point of beginning.