HomeMy WebLinkAbout896020Affidavit Of Survivorship
I, Elaine M. Crouse, being of lawful age and duly sworn according to law,
upon my oath. depose and state:
That under the date of November 27, 2001, for valuable consideration,
Leisure Valley, Inc., a Nevada Corporation, by deed of that date, which deed was
duly filed of record in the Office of the Lincoln County Clerk, on March 12, 2002,
in Book 485 of Photostatic Records on Page 091, conveyed to W. Ray Crouse
and Elaine M. Crouse as joint tenants, the following described property to-wit:
Lot 32 of Bridget View Ranches as platted and recorded in the
official records of Lincoln County, Wyoming
That by reason of said conveyance aforesaid, the said W. Ray Crouse and
Elaine M. Crouse became the owners of lhe above described land, and title
thereto vested in them continuously from the date of conveyance described in
said deed to the date of death of W. Ray Crouse, also known as Weldon Ray
Crouse, on the 2'~d day of July, 2003. That by reason of and upon the death of
Weld°n Ray Crouse, title to the above described real property vested absolutelY
in Elaine M. Crouse, as the surviving joint tenant.
Affiant avers and certifies that Weldon Ray Crouse is the identical party
named with Elaine M. Crouse in the aforementioned deed whose death
terminated his interest, title and estate in said real property; and Affiant attaches
hereto and makes a part of this affidavit, a copy of the Official Certificate of Death
of said decedent, duly certified by the public authority in which said death
certificate is a matter of record.
Dated this /(,..,-, day of ~C, , 2003.
fElaine IVi. Crouse
State of Utah )
)SS.
County of (~ ~ ~ i~-1 )
Subscribed and sworn to before me, a notary4:Lg, blic in and for said County
and State, by Elaine M. Crouse, this [ (p day of [..)~C - ,2003.
WITNESS my hand .and official seal.
F~, ~_,!~i-~i~ D. DENISON~
I
Notary Public
My Commission Expires:
RECEIVED
LIN.-,O,-~ COLI TY CLERK
AKA.
ORIGINAL
STATE
COPY ~" '
STATE:: OF ARIZONA
2o7
STATE OF ARIZONA -~ 0
DEPARTMENT..., , OF,::: HEALTH SERVICES - OFFICE OF VITAL RECORDS DEATH NO.
CERTIFICATE OF DEATH D 102-
B. MIDDLE C, LAST
RAY ~:' CROUSE
1936
(il ,'mi i~ USA, name cou~?}
(SPECII~t' YES OR NO)
e.: No
s~ow~ on C~TY
Sierra Vista
USUAC ,~.. STATE
RESIDENCE
RE'end
SPECIFY
lISA
IF ~DER t DAY
o( "! Sierra'Vista
U4S~O£ C~TY t ~&Uy$? :.
: (~CIFY Y,t~ or 'NoI ::?:
Drive Yes
2. Male 3. J 2, 2003
IF YES INO~CATE MEXICAN SPANJSH. I~.JERTD RICAN. WAS DECEASED EVER IN U.$. ARMED FORCES?
C UI~I. ETC. SPECIFY YES OR NO)
C. "; ' I~- Yes ': ::':'
C. HOSPffAL OR, (tF RES~E, GIV~ STRE~ ~DRE$~
~ DP EMER
2835 E. Sun Crest Drive
,. Married ~oElaine
,~.529-38-4961
85650
Utah
Claire Morgan
1~.~,o%%~,T~' .%~,.%.%~, .... oF .us,.Ess ,~R ,.OU~'rRV
,Ruperviso~ s.C iv'±l ServiCe
LON~ I~ ARIZO~%IA? I EDUCATION
' nIGHEST GRADE COMPLETED
6 Years
ELEM~NTARYSECON~RY I i / COLLEGE
-- A. (0' 12) (I ~1 ~ ~ +)
A. FIRST B. MIDDLE C. t~T
Ida' Deon Pitt
CITY AND STATE
ZIP CODE
)RCEMENT ':
tORITY
Io dealh but'not re'biting'in the"anded¥1~! cause given in Pad I
!::'"'"':!:i::- :!..:' DATE01~ .MO [~Y :::::: YR ~ HO~JI~ I NJURYATWORK3
~ '::: .:: :~'~:: , ::: ::~: /: a:-..:'f I '
15z 153 Mi~
(SIGNATURE)
AUTOPSY ".
(Spe~iy Ye~ of No) (Spedly Ye~ ~' No)
Yes
DATE REC'O IN STATE
STREET ADDRESS
CI1~ OR TOWN
(REV. I-sef
;::::: CERTIFIED COPY O:F VITAL RECORDS:;
STATE OF:XRI~OI~A I '
SS
COUNTY OF COCHISE J
DATE
ISSUED
: .... JUL 9.2003
:: .:: i:::i ~ii::' h': · :: :..' \
This is a true and.o~act reprodudtion of l~e document officially registered end to be
placed on file in the VITAL RECORDS SECTION, DEPARTMENT OF HEALTH SERVICES,
PHOEN!X, ARIZONA issued under me autDorify of A.R.S. 36-341. anq by direction
County Registrar
C~chise County Heallh Department
al in color and impressed with raised seal of issuing agency