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RECEIVED
LINCOLN OOUNTY CLERK
8 9 9 5 ~A~FIDAVIT OF IDENoT,I~¥,
u~.~ ~,r~ PH 3: ~ 6
I, WILLIAM CHARLES CHENEY, do duly state, tl~a[~per~'ona!ly'kne~ that
KlM PARKER CHENEY, as shown on the attached Certificate of Death,
is one in the same person as KIM CHENEY, as shown on deed #873884 in
book 466 page 499 of the official records of the Lincoln County Clerk as receiving
an interest as joint tenant in the following described real property;
LOT 6 OF RIVER RANCHES FISHING AND EQUESTRIAN ESTATES AT
FREEDOM, WY
hereby terminated.
STATE OF~O'
County of~~c'-'~
All interest of the decedent in said property under the joint tenancy !.ndicated above is
~;~l~i?le;g~~nt Day of 'L"~x~, 2004 ~rsonally app¢ e~before me
WILLIAM~RLES CHENEY, the//gt~ner of the ~ ~o duly
acknowledged to me that they executed~t~~same. ~Q t~n instrun~ ~
~¢~1~/.o~_~.q: ;~*4'~g I N~tary Public
Cmmnission Expires
· :. ii': E 1986668 B 3540
~A~;'I'MENT OF HEALTH
· ' ST E FILE N
:. ,. ~:!:~ ~,..:. ~;~.:,;~: ?. h. Fema e NOV 9 2003 07 04 ':
"J'( ::: ~'~ "~'"' Salt Lake City, Utah 529-08.2987
: William C. Cheney ~ --
,:!~'~'",,; JJudy Parkln
:,NFO"~XNT Dr~ve, Farmington Utah 84025
~,~. EC~h~ville Cemetery uenterv~xie, utah
~s ~ ~., ~.~ 2ns ~orth Main
:.? . :;,' ~7~:CERTFER ::;,:::. : ::,~,,,~;j~;.~,~:~?i~i, ~:,~:jt~ ~: ;:,~1 );:::t:::: ~'~': ~
', ~:~:i~:~ ;:: I 88-178121-1205 I NOV1 ,2 3 ·
.' f :. : - . ~ . . /,;~ ~;~:~ ; ~ z~ ~': '~ ~;~ ~. : :~ ', yf;~: ::/: ' :. :: ~: MU . Day, Y~
November
18,
2003
'2;:~ ::~' DEATH': ???;~y::E;:.:,:]:::'r "::?i?"~:}:TY~?:;)?:~j4~PfZ¢~ ' ~o Yes
>n :filb iff thi~ Office. This certified copy is issued :1953 As Amended.
i,CTOR OF VITAL RECORDS
El I 4 4 0
'~!:'; ' E 1986668 B 3540 P
]EPARTMENT OF HEALTH
HEALTH SECTION DATA- DEATH 2003 01148
;HENEY NOV 9,2003
i ':?<~ t Davis November
IN.~O01~ OPINIOH. TOBACCO USE 8Y THE DECEDENT
TiME OF INJURY 35c. INJURY AT WORK?
PRIOR TO COMPLETION~
OF C.¥~OF 01EATH?
, DEXTROMETHORPHAN. : 1
~ONE ,
~IN~. T~CCO USE BY THE DECEDENT
la: NAME OF PHYSICIAN OR MEDICAL EX-MilNER Pdnl m lype
E~:ard A Leis, M.D., Asst. Med. Examiner
)EC 23 2003'~
iN Medical Dr. Salt Lake City, UT 84113
I
~is certified copy is issued
',01
)R OF VtTAL RECORDS ' :: ::)?!,
'4 fl '3 i D *