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AFFIDAVIT OF SURVIVORSHIP
TERMINATING A LIFE ESTATE
STATE OF WYOMING )
) SS.
COUNTY OF LINCOLN )
RECEIVED 3/15/2005 at 11:40 AM
RECEIVING # 907056
BOOK: 580 PAGE: 768
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, VVY
I, VIVIEND. CARLSON WHITE being of legal age and first duly sworn, deposes and says
as follows:
1. That Nellie Irene Carlson, the decedent mentioned in the attached certified copy of the
certificate of death, is my mother and she is the same person as Nellie Anderson Carlson,
also known as Nellie I. Carlson named as one of the parties in that certain Quitclaim Deed
dated January 23, 1986, executed by Nellie Anderson Carlson, also known as Nellie I.
Carlson granting and conveying real property to Douglas R. Carlson, Edward J. Carlson,
Diane L. Carlson Simms, Nancy I. Carlson Anderson and Vivien D. Carlson White as joint
tenants with rights of survivorship reserving unto herself a life estate in said property. That
deed was recorded as Instrument Number 649416, in Book 235PR at Page 189, on January
23, 1986, of the Official Records of Lincoln County, State of Wyoming, and concerns the
real property situated in the County of Lincoln, State of Wyoming and described as follows:
Lot Nine (9) of Block Forty-three (43) of the First (1 st) addition to the
Town of Kemmerer, as surveyed, platted and recorded in the Office
of the County Clerk and Ex-Officio Register of Deeds in and for the
County of Lincoln, State of Wyoming, together with all
improvements and appurtenances thereon situate or in anywise
appertaining thereupon; excepting and reserving therefrom the
easterly one foot of said Lot Nine (9), the same being a strip of land
one (1) foot in width and one hundred forty (140) feet in length on the
easterly side of Lot Nine (9).
That I am the same Vivien D. Carlson White mentioned in the above referenced Quitclaim
Deed and thereby am a person interested in the effective property or the title thereto and
pursuant to § 2-9-102 W.S. (1980) hereby make the death a matter of record and certify that
upon the death of Nellie Anderson Carlson, also known as Nellie I. Carlson, her previous life
estate in the property was terminated.
Carlson~Affidavit of Survivorship
3. That the certified copy of the certificate of death indicates that Nellie Irene Carlson died on
January 23, 1999 in the City of Evanston, County of Uinta, State of Wyoming.
Dated this ~ ~ day of March, 2005.
VIVIEN D. CARLSON WHITE
STATE OF WYOMING )
) SSo
COUNTY OF LINCOLN )
Subscribed and sworn to before me by Vivien D. Carlson White, this /',/L~ day of March, .
2005.
NOTARY PUBLIC
My Commission Expires:
CarlsonXAffidavit of Survivorship
2
is a true and exact repro'duction of the document
office of Vital Records Services, Cheyenne, ~Wy
Deputy state Re~tistr'ar
-[~is copy is not valid unless it bears a raised seal llticolored security paper. ..- - .-.
f~c,~,~v )~ ~ n~l ,,. , ,'. . ~' ~ ~ ~m # mm~ .... ~:'~- ~:'~' ,l
Uinta [ Evanston
"'~Yes'-" .c:X ~..[3,~,,.~,~, White 13 ""*': "l
A · Anderson ' Bertha .... ~ ..nderson *,
ViVian.~hite.' ,!-;-,:,,¢ ,. ,
Kemmerer 83101
:remation Jan. 25, 1999 Garner Funeral Home
Crandall, Funeral Home - -1