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STATE OF WYOMING
COUNTY OF LINCOLN
AFFI]JA 5IT
REOEIVED
LINCOLN COUMTY CLERK
Ok SEP l AH 10:
I, June B. Hellstrom, being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America over the age of 21 years, and a
resident of Salt Lake City, Utah
That I was well and personally acquainted with John A. Hellstrom in that certain
Warranty Deed recorded 11-29-78 ,Book 151 P.R., atPage 114 in the office ofthe
Recorder of Lincoln County, Wyoming.
That I know of my own knowledge that John A Hellstrom in the said deed and John Armstrong
Hells trom mentioned in the attached Certified Copy of Certificate of Death was one and the same person.
This Affidavit is intended to terminate the joint tenancy (the life estate) of
John A. Hellstrom in the following described property:
Lot 45 of the Alpine Village Subdivision One as filed and platted in the Lincoln County,
Clerk's Office in Kemmerer, Wyoming.
/fffune ~. Hellstro~-'~'~ka June- B-. Hellstrom
Subscribed and sworn to before me this
Residing in:
Commission expires:
8th day of September 2004
(
~IIIIII~.I~,I, II
~ Notary l-'UOllC
I JEFFREYC. McMULLIIM
· ,~.~/ .IIM~p~I[~i~. l~l 4343 Cenlury Drive
I¢[ ~,~' I~l ~,, LakeCily, Utah 84123
I ~~ ~cember 1.
. ~ State ol Uta~
CERTIFICATE OF DEATH
LAST RACE (While, BlaCk Am.
s~.J~ ·
,,.--~,."mJ}nu ~. White
,th,Day,Year) :
Nev~ M~i~ J EDUCAT~N--ISp~Ify onl
Self Empl;~''':: June
Ve~ ~A~mStrong
Y~s .o
June
I=,T~ *NO Z,, coo~ 3032
[~. utah 'g~i17 Hollad~
~ Inpalienl CITY OR TOWN
. ;, :.
· EniOmbmeni
COImlllO~S IF
WHICH a~VE ma !
THE
: LOCAL REGIS ,I'~AR. Slonat ur e '
aY "Utah
~p
RiES ;
IUT NOT RELATED TO THE ~,, ,
Month,Day,Year) IE OF INJURY
0/20/88 ~; ~
R TOWN, ;Die.ce ~ pl~ of Inju~ to
: ,..unKuown Mi~
{e on file i6 thi~
AnnOtated,
:e, This certified