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THE STATE OF WYOMING )
) SSo
COUNTY OF UINTA )
RECEIVED
LINCOLN COUNTY CLERK
0566
ANN L. CAZIN, f/k/a ANN LAMBORN, be±rig first duly sworn upon
her oath, deposes and states as follows:
1. On the ~9th day of May, 2004, DONN~ %UCZ%%E L_~v~BORN, died,
as is evidenced by the offic±al certificate of death attached
hereto and incorporated herein by this reference.
2. At the time of her death, Donna Zucille Za~born ~ointly
owned certa±~ real property with me and others, said real property
being located in the County of Lincoln, State of Wyoming, and more
particularly described as follows:
An undivided one sixth (1/6) of the South 90 feet of the
Lot No. 12 of the Block No. 42 of the First Addition to
the Town of Kemmerer, County of Lincoln, State of
Wyoming~ as surveyed, platted and recorded in the office
Of the Lincoln County Clerk and Ex-Officio Register of
Deeds.
TOGETHER WITH all improvements, rights of way, buildings,
and all things appertaining thereto.
3. Said interest in real property was originally conveyed to
DONNA LUCILLE LAMBORN, DON LAWRENCE LAMBORN, RODNEY LAYNE LAMBORN
and ANN LAMBORN, as joint tenants with right of survivorship, by
Warranty Deed dated October 3, 1979, and recorded in the Office of
OUOg 35 0527
the Lincoln County Clerk and Ex-Officio Register of Deeds on
October 3, 1979, in Book 160PR at' Page 456. ..
4. By reason of Donna Lucille Lamborn's death, DON LAWRENCE
LAMBORN, RODNEY LAYNE LAMBORN, and ANN L. CAZIN, f/k/a ANN LAMBORN,
ownership of the above-mentioned real property
are entitled to
interest.
DATED this
day of ~h , 2004.
~IN,~/~AMBORN
j UBSCRIBED AND SWORN to and acknowledged before me this
~ day of ~%~ , 2004, by ANN L. CAZIN, f/k/a
ANN LAMBORN.
WITNESS my hand and official seal.
My Commission Expires ~....~$$~o~:..~
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2
¥OMING ·
!NT OF HEALTH
2
LOCAL FILE NUMBER 1017
CERTIFICATE OF DEATH
.i. .SOO~t,~CURIT¥/:I. UMI3ERi[i!. ~i ' 5a.A~'--La~i~t~lf"]SbU~OES ~'E6~" '[~NO~R DAY
528
- - 74 : [ : ~ August 15, 1929' ' ,
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~ = South Lincoln Medical Center ~ ~ ~-~t'-J :'~'K~erer ' ' .
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Don Lombp~:p?,i.,!,~ ..... "(],~.'":5~-SoW~:='~<~ i'~'::::'? :.:';':,::' 1906' C~lhoun' COuntY Rd '~::3~
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~. R~G~ST 38~ DATE RECEIVED BY REGISTRAR M~ay~ '
This is a true and n of the d~cument
R~ords Sp~'ices, Cheyenne Wyoming. '
DATE. ISSUED:
This copy is not valid unless prepared on pa cr w tl} an ~ngrav
~ of Vital
'::?I! :::ii: I i::'" Luci'~da'M¢O;ffre~: /~4
Deputy Stl}te qegistra~