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STATE OF WYOMING
COUNTY OF LINCOLN
BOOK_.__~ P/:'G ' ~ g;,
AFFI-DAVIT OF SURVIVORSHIP
RECEIVED
LINCt,[ t,l COUH"fY CLERK
I, YOSHIYE TANAKA being of legal age and first duly sworn, deposes and says as follows:
That Teruko Tanaka, also known as Trudy Tanaka, the decedent mentioned in the attached certified
copy of the certificate of death, is the same person as Trudy Tanaka named as one of the parties in
that certain Quitclaim Deed dated April 3, 1991, executed by Yoshiye Tanaka, Tmdy Tanaka, Chiyo
Okamoto, Herbert Okamoto, and Hish Tanaka to Yoshiye Tanaka, Trudy Tanaka, Chiyo Okamoto,
Irish Tanaka, David M. Okamoto and Jeff C. Okamoto as joint tenants with rights of survivorsl'filh
recorded as Instrument Nmnber 745708, in Book 308PR at Pages 165 and 166, on March 20, 1992,
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:
Lot 8 of Block 45 of the Second Addition to the Town of Kemmerer, Lincoln,
County, Wyoming as described on the official plat thereof.
That an Affidavit Terminating Estate by Joint Tenancy was filed in the Official Records of Lincoln
Cotlnly, State of Wyoming in Book 315PR at Pages 120 and 121 as Instrument No. 753920 on
September 8, 1992 making the death of Chiyo Okamoto, also known as Chiyoko Tanaka Okamoto
a matter of public record and thereby temalnating her interest, title and estate m the said real
propertY.
That I am the same Yoshiye Tanaka mentioned in the above referenced Quitclaim Deed and thereby
am a person interested in the effective properly or the titl~ thereto and pursuant to § 2-9-102 W.S.
(1980) hereby make the death a matter of record and certi fy that upon the death of Teruko Tanaka,
also known as Trudy Tanaka, her previous estate m the property was terminated.
That the certified copy of the certificate of death indicates that Teruko Tanaka, also lmown as Trudy
Tanaka died on June 13, 2004 in the City of Kemmerer, County of Lincoln, State of Wyoming.
Dated this /q~t, day of July, 2004.
STATE OF WYOMING
COUNTY 017 LINCOLN
YOSI~IYE TANkKA
Subscribed and sworn to before me by Yoshiye Tanaka, this /y !~
~-, NOTARY PUBLIC
~ MY COMMISSION EXPIRES ~~
/
_ . day of July, 2004.
,.,,STATE. O F.,,WYO Mi N.G
~.~Z~{L~'~} ~Z~. !i:::::. DEPARTMEN~ OF HEALTH
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LOC^LF~LE~U~eEa ].{)23 CERTIFICATE OF DEATH
52 - 3 . 63 .]~' 7 1, I, m I April 13. 1926 "' .
::.: : . .. ' : ' : :.. ' ' . .'. . ....::..~a P~G~OEDEATH(C~
~ ~ Soutl{ I 5/Kdmmerer ~ [ Lincoln
Dc ' '"~.,~mL,t OJ~a ~' Kemmerer Cemetery ge~erer. W o~in
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This Js a tree and exact reproduction of me aocumen[ on file in the office or' Vital
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Depu[y 5tare Reg sitar
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