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AFFIDAVIT
STATE OF WYOMING
COUNTY OF LINCOLN
I, Lydia I. Corsi fka Lydia I. Steglich
oath, depose and say:
RECEIVED 2/1/2005 at 10:26 AM
RECEIVING # 906204
BOOK: 578 PAGE: 176
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
, being first duly sworn on
That I am a citizen of the United States of America over the age of 21 years, and a
resident of Etna, Wyoming
That I was well and personally acquainted with Jerrold K. Steglich in those
certain Warranty Deeds recorded August 27, 1991 , Book 300 P.R., at
Pages 375 and 376 in the office of the Recorder of Lincoln County, Wyoming.
That I know of my own knowledge that Jerrold K. Steglich in the said deeds
and Jerrold K. Steglich 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
Jerrold K. Steglich in the following described property:
Lots 53 and 54, LEON LIVINGSTON SUBDIVISION, Lincoln County, Wyoming.
Lydia I. Steglich
Subscribed and sworn to before me this 31 day of .lanuary
,2005
Residing in: L-incoln County
Commission expires: 9-15-07
Notary Public
STATE OF UTAH - DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
STALE F~LE NUMBER
. 017'?
This
~-- U
Co"nt
Rog:st
:~ J~'~6'id ', STEGLICH I Ma].e [December 20,Z994/ 02ZO
Oct 26;LDZD:'t Salt Lake City, Utah 15~8 32 9135;
? ';;. ~' f' "/.f?~e ~~ 8b NAME OF HOSPITAL, NURSING HOME OR OIRER F~~
HOSPITAL~' ~ Lf. ~/.~ ..;'.(~?;'Q' ~'7~'~/;]'~' '.~ QT~; :. J . . g~vaslceelad~ressoll~aiion) .
8c CITY TOWN DB LOCATION DF'DEA~. f.: ~d. ~0U~TY OF DEATH g SURVIVING SPOUSE OI wde. ~ive rnmden,ame :
Cen~ervi'li~,~-;~??L'(~i: ,.7), Davis Lydia Ibarra
ARMED 60R~6~? :; ~ ~ev~jr.~art'e~. ~ N~r'i~ '
0,~, ~;':',,i;O~,,~;~;~ ':~}"0~-.~ Pipe Line Inspecto~ Mountain Fuel
..~;~- "'~~%~-r'~?/ ':,/~ Centerville Davis Utah
~7 FATHER'S NAME ~r~. M ~1~. ~J~ .~' ~ ~ .' ~ ~: 18 MAIDEN NAME DE MOTHER Firs~ MEddle. Last)
Kar~.~req~r~]c.~;:~.S~:eg%%'ch;:: ' · Stella Garn '
tg N~4E/RELATIO~SHIP ~f19 ~A~IHG ~OpflE~S OF INFgflMANT
North 475 West, Centerville, Utah 84014
~ IDac 22 lqqJ~ [~ v~=w m=mu~a~ [ ~o~u m. LaKevlew Drive
, 'L',;,, ,,C f~.,r, ' . ~ - - ~fi ~ Rm,nr~fu]
22~N~TORE~fU~0yIq~¥O~EE ' 123 LICENSEENOMBER [24 FUNERAt HOME (Name. addmssandticensenum~0 ~ - - ·
/J .IH:r,5[¥:'I-::Vd[',t I I Hemo~ZaI ~sta~es Mortuary #lSi
"~[[I~I[YI~"~[~ I 621 [ 5850 So. 900 E. SLC, Ut. 84121
25.1. D~TED TE DECeaSeD ~S ~Sl.TM .]/:?~ ' ~ ~
;:.~ ~edge, 0ealh ....... d al Ihe time, rial .... d pi ...... d due lo Ih ...... (s) and mann ..... laled
E'l%%be:~h'~{;:~';~r'yg:tas~"}MD· 324 lOth Ave, SLC, Ut. 84103
Off fie ~pI~ATQR~E~}, Stl~, O~ HE~I EAI~flE, tlST O~Ly ~4E CAUSE O~ EACH LINE Belween Ons~ And
IMMED~ATECA~SE(FipaI~'"I~.~ ]k l ': ~/' O ,/ . ~ ·
cause: E01er. UNDEflL~IN~:/~:;'?;;j'5 '.,! '.~:if;~:~i&:~. 5 .' . [ ' -
p~RT I O h~ Sgnil~i'~l~i'dfii~ib~li~g ~e~ bb~ ~o 32 IN YOUR OPINION. TOBACCOUSE BY THE DECEDENT 33a WASAN 3~. WERE AUTOPSY
resul,qg jet~.....~_ ~.. ~ ~ r ~:;:-'.--;.-. - .: .; b qd ~r [Y~Pg'E~ g~/~ ~ ~ ~ '~ ~ ''~" ~ ::¥' ': ': D Probably contrm~led Io Ihe cause ol deathAUTOPSYPERFORMED? PRIORFINDINGS AVAILABLE
34. M~N~R O~DE~TH j. ?j~'j':~ ~5~ DAT6'OF N~U~Y "(': ] 35b TIMe--N JURY I 3~ INJURY AT WORK? 35d PLACE OF INJURY-At hohze
, A~id~h~ly '~;~ 5 ~ ~/~;{'t '~ ~ ~:~'~2 (,~:'~]:,,:~: 5 '~[ ~Z-; :~),; ,
ate on file in this office. This certified copy m ssued
~,nnotated, 1953 As Amended.
-.John E. Brockert
rECTOR OF VITAL STATISTICS
i;, ¢,5 ·, T'--- .........