HomeMy WebLinkAbout895319 STATE OF WYOMING
COUNTY OF ~
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895319
RECEIVED
LINCOLN COUI'4TY OLERK
,JEANNE WAGNER
AFFIDAVIT TERMINATING ESTATE BY ENTIRETIE',~:''~ .......... ":'~ ~'"~
death certificate of Glenn Larson,
authority in the State of Wyoming,
certificate is of record.
SADIE LARSON, being first duly sworn according to law, upon
her oath deposes and says:
That by virtue of a Quitclaim deed dated June 3, 1991, and
filed June 3, 1991, in the office of the County Clerk and Ex
Officio RegiSter of Deeds in and for Lincoln County, Wyoming, and
duly recorded in Book 297PR at Page 285 of the records thereof, the
Affiant herein became one of the owners of Lobs Numbered 6 and 7
in the Quadros First Addition to the Town of Cokeville, Lincoln
County, Wyoming, said deed running from Glenn A. Larson and Sadie
Mae Larson to Glenn A. Larson and Sadie Mae Larson, husband and
wife, and Betty Jean Lloyd and Errol Jack Lloyd, wife and husband,
that on said June 3, 1991, when said original Quitclaim deed was
executed and delivered, the Affiant herein, one of the Grantees
named in said Quitclaim deed, was the wife of Glenn A. Larson, one
of the'Grantees named in said Quitclaim deed; that by reasons of
said Quitclaim deed, the intention of Glenn A. Larson and Sadie Mae
Larson and the'existence of the unities of time, title, interest
and possession, the fee title to the above described premises was
vested in ~said Grantees, and continued to remain vested in~ them
until the 12th day of September, 2003, upon which date the said
Glenn A. Larson died at Green River, Wyoming, a resident of Goshen
County, Wyoming, thereby terminating said Glenn A. Larson's
interest in the above.described real estate, leaving the title
thereto vested in Sadie Mae Larson with a one-half interest and
Betty Jean Lloyd and Errol Jack Lloyd owning the other one-half
interest as an estate by the entireties.
Attached hereto and made a part hereof, as provided in Section
2-9-102,'Wyoming Statutes 1977, is a certified copy of the official
certified to by the public
in which the original death
'~ADIE LARSON
Subscribed in my presence and sworn to before me by SADIE
LARsoN this /~ day of October, 2003.
- VN~tary Public
My Commission Expires: (COuulYOF ~'SIATi;F
FOH
INSTRUCTIONS
SEE
HANDBOOK
LOC.,~L FILE NUMBER
DECEDENT-NAME FIRST
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
GLENN ALFRED LARSON I Male
ISa. ~-L.~al Bi~UxJay Sb. UN0~R 1 YEAR Sc. UNDER t DAY
HOSP1TAL [~lnpatie~t [::]ER/Outpatient [~DOA I°ruER: [::]Rea~-x:e F-Jotr, er (SpecJ/),/
Castle Rock Convalescent Center I Green River
Wyoming Married [ Sadie Mae Patterson
'747
Septe~nber 12, 2003
April II, 1920
J ?d. COUNTy OF DEAIN
Sweetwater
Rancher Cattle
,3a. RESIDENCE- STATE ]lab COUmY t3c. CO'Y, IOWN OR LOC~TION I,ad. STREET mO NUMeER
Wyoming { Goshen Torrington { 104 Antelope Lane
No NO~ v,, O r~ [ ~Vhite .
Albert John Larson Bertha Lorraine Twiss
Mrs. Betty J. Lloyd Daughter
14 Fairview Drive Rock Springs, Wyoming 82901
Cremation Sep. 14, 2003 White Mountain Crematory
J Rock ~prings, Wyoming
~ ~ ~ 485 Vase Funeral Home 85 Rock Springs, Wyoming
~ :2d. NAUEOFAmN~NG~IC~NIFOTHERI~,CE~iFiEha~a~i IJ~ September'12, 2003 J 8:39 P M
24. N~E AND A~RE~ ~ CE~IER (~Y~AN ~ C~ONER)ff~ ~ ~J
~i~th}~ , Dilated Cardiomyopathy ~ Years
~. Myocardial Infarction ~ Years
VR 2-89
11/99 15M ~ ,
4ANNER OF DEATH 3Da. DATE OF INJURy 3Ob. TIME OF 30c. INJURY AT WORK? 3Od. DES4::RIBE HC3N I~URY ~CURRED
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// VAlgEFUNERAL HOME
154 Elk Street
Rock Springs, Wyoming 82901
DATE ISSUED September 17, 2003
THIS IS TO CERTIFY THAT this is a tree correct conformed reproduction of the original
copy of the de.ath certificate r2ompleted by the VASE FUNERAL HOME and submitted
to the VITAL~CORDS SERVICES, Wyoming Department of Health and Social Services,
Divisioh:0f He,th/and Medical Services at Cheyenne, Wyoming
STATE OF WYOMING)
COUNTY OF SWEETWATER )ss
Subscribed and sworn to before me a Notary Public
this 17th da of Septe~nber , 2003
M.}~.~, ~!nfission expires on April 21, 2006
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