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AFFIDAVIT OF SURVIVORSHIP RECE lYE D
,L1NCOLI"I ¢,OUN'i'Y CLERK
898516
CO~TY OF L~COLN )
1, DOROT~ ~ BO~O, also ~own as DOROT~ JE~ B~TER BORIC, being
of legal age and first duly sworn, deposes and 'says as follows:
1. That ~ando P. Borino, the decedent mentioned in the attached certified copy of the
ce~ificate of death, is the same person as ~ando P. Borino named as one of the proxies in
that ce~ain Quit Claim Deed dated March 7, 1975, executed by ~ando P. Borino to
~ando P. Borino and Dorothy Jean Baxter Borino, husband and wife, as tenants by the
entireties, recorded as ~stmment Number 464860, on March 13, 1975, in Book 117PR at
Page 487, of the Official Records of Lincoln County, State of Wyoming, concerning the real
property situated in the County of Lincoln, State of Wyoming and described as follows:
Parcel 152 of the Town of Diamondville, Wyoming, as shown upon
the plat thereof dated August 31, 1942, containing 5625 square feet,
more or less.
Parcel 154 of the Town of Diamondville, WyoBfing, as shown upon
the plat thereof dated August 31, 1942, containing 5625 square feet,
more or less.
That ~ando P. Borino, the decedent mentioned in the attached certified copy of the
certificate of death, is the same person as ~ando P. Bofino named as cue of the pmties in
that ce~ain Quit Claim Deed dated March 7, 1975, executed by ~]ando P. Borino to
~ando P. Borino and Dorothy Jean Baxter Bofino, husband and .wife, as tenants by the
entireties, recorded as ~stmment Number 464861, on'March 13, 1975, in Book 117PR at
Page 488, of the Official Records of Lincoln County, State of Wyoming, concerning the real
property situated in the County of Lincoln, State of Wyoming and described as follows:
Parcel156 in the Town of Diamondville, Lincoln County, Wyoming.
That ~ando P. Bofino, the decedent mentioned in the attached certified copy of the
certificate of death, is the same person as ~ando P. Bofino named as one of the parties in
that ce~ain Affidavit dated Febmaw 18, 1987, executed by ~ando P. Borino and Dorothy
Jean Borino, recorded as ~stmment Number 669256, on March 2, 1987, in Book 248PR at
Page 576 of the Official Records of Lincoln County, State of Wyoming, indicating that the
Parcels 152, 154 and 156 located in Tracts 45 and 38 of the Resu~ey of T2N, R116W, 6th
P.M., Lincoln County, Wyoming are now known as Lots 7, 8, and 9 of Block 1 of the Follies
of 42 Addition to the Town of Diamondville, County of Lincoln, State of Wyoming.
That I am the same Dorothy Jean Baxter Borino mentioned in the above referenced Deeds
and Affidavit 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 ofArmando P. Borino, his previous estate in the property was terminated.
That the certified copy of the certificate of death indicates that Armando P. Borino died on
August 1, 2003 in the City of Kemmerer, County of Lincoln, State of Wyoming.
Dated this ' -/f~';~'day of April, 2004.
DOi{OTHY
J,~A~ORINO also known as
DOROTHY JEAN BAXTER BORINO
STATE OF WYOMING )
) SS.
COUNTY OF LINCOLN )
Subscribed and sworn to before me by Dorothy Jean Borino, also known as Dorothy Jean
Baxter Borino, this /~/~ day of April, 2004.
My CO~,IMISSION EX'RES ~ NOT~Y P~LIC
My Commission Expires:
/ /
2
INSTRUCTIONS
:' :'.' SEE :
ArmandO
520-14-6955
WyOM
STATE lNG
..... %:~;: : DEP~::R~M~i~~ OF HEAETH . . :' ~ r -- z~43
STATE OF WYOMING
:iii DEPARTMENT OF HEALTH 2 0
,::.~.CERTIFICAIE OE DEATH
August 1, 2003
South Lin=c'~Zln¢:N~rs:
~yoming
March 2, 1920
.." "/Do~0thy JeO~ Baxter
.~,~-.. '"Lincoln County
9i5.~i.i Sr~. Kemmerer ~.
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