HomeMy WebLinkAbout904228 RECEIVED
0 5 ?_~RP!i'~': 0~.~87 Affidavit Of Survivo,'shit)-INCOLN COUNTY CLERK
L Lo~aine Kovalsky, being of law~l age rout dulv,~zt~acco~
upon my oath, depose and state: ,~::.,~,~1~ ~,~ ~ v~'A~;p~T_ ~ lazo,
~at under the date o/ December 27, 2001, ./Dr valuable consideration, Leisure
Valley, Inc., a Nevada Co~oration, by deed of that date, which deed was duly filed of
record in the Office of t~ Lincoln Coun~ Clerk, on March 12, 2002, in Book 485 of
Photostatic Records on Page 090, conveyed to Robert Kovalsky, Ir. and Lorraine
Kovalsky, as joint tenants, the following desc~bed property to-wit:
Lot 468 in Star Valley Ranch R V Park Plat I as platted and recorded in
the official records of Lincoln County, Wyoming
That by reason of said conveyance aforesaid, lhe said Robert Kovalsky, Jr. and
Lorraine Kovalsky, who were husband and wife, became the owners of the above described
land, and title thereto vested in them contindously fmm the date of conveyance described
in said deed to the date of death o/Robert KovaIsky, ir., on the 8th day of July, 2004.
That by reason of and upon the death of Robe~'t Kovalsky, Ir., title 't~ the above described
real property vested absolutely in Lorraine Kovalsky, as lhe surpiwng joint tenant.
Affiant avers and certifies that Robert Kovalsk~/, lt. is the identical party named
with Lorraine Kovalsky in the aforementioned deed wJ/ose death terminated his interest,
title and estate in said real property; and Affiant attaches hereto and makes a part of this
affidavit, a copy of the Official Certificate o/Death of said decedent, duly certified by the
public authority in which said death certificate is a math,r of record.
Dated this ~4~ day of ~~d, SL2004.
)SS.
Lorraine Kovalsldyf,
Subscribed and sworn to befo, re me, a noJ~d public in and ,for said County and
State, by Lorraine Kovalsky, this ~ day of (_J~'~',-, ~z.~ , 2004.
WITNESS my hand and official seal.
st t. o, [
]~.~ ~.~~?~~,~7[
3~,~,~ C~n ~ DO 254974 ~
' l~ot]ary Public
My Commission Expires:
MIDDLE
!STATiSTiCS .',
~PY
DEATH
LAST
,~,~ KOVALSKY, JR. -~
'.n AL, E-Last B~rthcla¥
"Residrrl.' X 3m,,, (Spec#}/)/ri}lL
MARITAL STATUS
r'Married,
Divorced (Specify)
13d STREET AND NU:
4532 W. K~
1% HACE -
Cuba~. [3lack Wh~le.
Yes SHecdy:
,, White
,FI[,'¢I M~ddle. ·Maiden Surname)
Amelia Siniscal¢hi
Kenned7 Blvd. ~197
FL¸
ARk, t~ FOF
. ~ es~
9b. INSIDE CITY LI
3027
21~. NAME AI'~L} AL}ORESS OF
Hopewel 1 Funeral:
6005 South S.R. 3
~ ~ (Signalure and Title) b
~-X 23b L)A[IJ SIGNED (Mo,,
~ F, 23d I~EDICAL EXAMINER'
Plant
· 'lailure.
EOn:
AUTOPSY
27b. WERE
OF
WAS PERFORMED
4¢20 DESCR;BE
(SI,t.,~,t ,m,l ;4unlb~
RECORD
State
SECU[tll Y PAPER
r_WtTHoHr V£RIFYING THE;~[
AND,
THE~4MOCHROMIC