HomeMy WebLinkAbout894589 AFFIDAVIT OF SURVIVORSHIP RECEIVED
~INCOLN COUNTY CLERK
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I, Barbara Christenscn, being of legal age and first duly sworn, depose and say as Follows:
STATE OF WYOMiNG
COUNTY OF LiNCOLN
1. That Ralph Roy Christensen, the decedent mentioned in the attached certified copy of the
certificate of death, is the same person as Ralph Ctuistensen named as one of the parties in
that certain Warranty Deed dated January 25, 2001, executed by T. Wayne Stubbs and Lisa
M. Stubbs to Ralph Christensen and Barbara Christensen, husband and wife, recorded as
Instrument Number 870980 on January 29, 2001 in Book 458PR at Page 706 of the Official
Records of Lincoln County, State of Wyoming, concenfing the real property situated in the
Cotinty of Lincoln, State of Wyoming and described as follows:
The Lot Nnmbered Twelve (12) of the Block Numbered Thirty-Three
(33) in the First Addition to the City of Kemmerer, Lincoln County,
Wyoming as described on the official plat thereof, 'together with all
buildings, improvements and appurtenances thereon situate or in
anywise appertaining thereto. Subject, however, to all restrictions,
reservations, easements and rights-of-way of record, of sight or in
use.
Also known as 401 Pearl Street, Kemmerer, Wyoming.
That I am the same Barbara Christensen mentioned in the above referenced Warranty Deed
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 Ralph Christensen, his previous estate in the property was terminated.
That the certified copy of the certificate of death indicates that Ralph Roy Christensen died
on the 23,a day of May, 2003 in the City of Salt Lake, County of Salt Lake, State of Utah.
Dated this~ day of October, 2003.
BARBARA B. CHRISTENSEN
STATE OF WYOMING .
COUNTY OF LINCOLN
Subscribed and.sworn before me by Barbara B. Cbristensen on this
October, 2003.
My Cmnmission Expires:
Probate\Christensen\A ~davit of Survivorship
NOTARY PUBLIC
day of
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.... ~,~.~,~o,~,,o~o~ ';::':~:.: '' STA:TE OF UTAH - DEPARTMENT OF HEALTH
' ....... ~: '": ..... .CERTIFICATE OF DEATH
:/': tb~AL ¢il~E NOMeER i 18--2392
8s. PLACE HgSPITAL f~tus eoS,, ~ Hesp~,l e~: l A~L OTR~R LOCATIONS: 8b ~E. gF ~O~AL N~R~IN~.HOM~ pR 9~ER FAGIL~ .- . ·
, -~ un varsity HoSp tel
D~ED~" IO. WASOECEDENT . lt. MARITALSTATUS ' ' . , 12a. DECEDE~SUSU~OCCUPATI~ (~~ 12b. KINOOFBUSI~ESSORI~DusTRY
I~F6~Ah~" I~'Nm~RE~YIOUSHIP'~DMAILINGADOEESgOEINFO*MANT) : '"~min 83
'~[.:E~i'~?~ ~AC~{a~g Bi'Christensen (wife) :' 40~ Pearl Street, Ke~erer, ·
<: ~ ~5 ~:::;:~ OA RESPI~TOR? a~$,t
any. leading ~6 Immediate
CAUSE (diseaSe br in u~ that '
~A~0F. ~l,olresullldglnlheu~e¢~g~useg~eht~P,~l . ~, :' : ~ N N S R PERFORMED7 : ' F~I~AVA~BLE
This is to certify th,At thig'i§:a true copy Of the Certificate Off 'file in this off cd Th S'cert f ed copy is issued
unde¢: ~utho¢ ty bf ~i~dt ~ii 26:2~22 of the Utah Code Annotated i953 As Amended
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OatelSsued: : ,~,,:~ :~:.:~. :':::~.: r) .:4 :~ :~
~'. :v ' )HAY 29 ;': 2003 ~ ' ~.).zi,,~7 ,/
' .. ":': ·i :'::~;':,:.:':;';:::.? ~ ~ ~"~dy ' x"~'~
County S..A[.¢ '~ i:.! Barry E. Nangle
DIRECTOR OF VITAL RECORDS
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