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STATE OF WYOMING
AFFI 39/ 'P¢-
REO£1VED
LINOOLI~'I .¢,Ot,l~.lTY CLERK
COUNTY OF LINCOLN
l, Robert B. Hilbert, being first duly sworn on oath, depose and say:
That I at!! a citizen of the United States of America over the age of 21 years, and a
resident of
That I was well and personally acquainted with Dona Jean Itilbe~t in that certain
Warranty Deed dated January 4, 1982, Book 183 P.R. at Page 663 in the office of the Recorder of
Lincoln County, Wyoming. Said Dona Jean Hilbert was also lcnown as Dora Jean Davis Hilbert.
That I know of my own lmowledge that Dona Jean Hilbert in the said deed and Dora Jean
Davis Hilbert mentioned in the attached Certified Copy of Certificate of Death was one and the
same person.
This Affidavit is intended to terminate the joint tenancy (the life estate) of Dona Jean
Hilbert aka Dora Jean Davis Hilbert in the following described property:
Lot 118 Star Valley Ranch Plat3 as Platted and recorded in the official records of Lincoln
County, Wyoming.
ert B.~
Subscribed and sworn to before me this I ~l'q day of November, 2003
Notary Public
Residing in: /-.-'~
Commission expires:
UTAH' DEPARTMENT OF HEALTH 1 4 3 51 5 0
CERTIFICATE OF DEATH
Robert B. t~l~t (husband)4888 ~or Salt ~ke City, Utah 8~117' ...'~./ ;.. 71;'::'
~ ~E'XAMJN~NFORC~~ .....
, ; , On Jhe basi~ DJ e~eminahon anCoT invesligalion~ in my opinion, dealh oc~ffed al the lime. dale, place, a~ due Io lhe cause(si a~ manne~.~s ~JaJ~[~' :: ;'
' · ~ ' ' :q ;~; ,.' -: 351. OESCRtS~ ~W.INJUR~ ~CURR~6 (~1~, ~e~e o~ ave~t~ wh{~ msuE~ in Injuw, NATURE O~ INJURY S~0 8E ENTERED tN I~EM ~:J.j:::-,
This is to certify thai thi~:J~:
under authority of Sec[Jori 26f2.
APR:O
~. Date Issued:
,'r'
;>
SL 819553
6~rtificate on file in this office. This certified copy is issued
Annotated 1953 As Amended.
John E. Brockert
DIRECTOR OF VITAL STATISTICS