HomeMy WebLinkAbout907312 RECEIVED 3/29/2005 at 9:54 AM
RECEIVING # 907312
BOOK: 581 PAGE: 711
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF DEATH OF CO-TENANT
STATE OF VVYOMING
COUNTY OF LINCOLN
Lola Frances Roth of 108 County Road 151, Smoot, Wyoming 83126, and
upon her oath deposes and says:
That Edward James Roth, the decedent mentioned in the attached copy of
Certificate of Death, is the same person as named as one of the grantees in that
certain Warranty Deed dated the 30th day of September, 1991, executed by John
T. Klingensmith and Cheryl A. Roth Klingensmith, husband and wife, grantors, to
Edward James Roth and Lola Frances Roth, husband and wife, as tenants, by
the entireties, grantees, and recorded October 1, 1991, as Instrument No.
739129 in Book 302 of PR, page 99, of the Official Records of Lincoln County,
Wyoming, covering the following described real property located in Lincoln
County, Wyoming, to-wit:
Commencing at the Southeast Corner of the SW ¼ NE ¼ of
Section 31, T 31 N, R 118 W, 6th P.M., Wyoming, and
running thence North 11 rods, thence West 20 rods, thence
South 11 rods, thence East 20 rods to the place of beginning.
EXCEPTING THEREFROM the following described
tract of land: Beginning at a point which is 245 feet West
from the Southeast corner of the SW ¼ NE ¼ of Section 31,
T 31 N, R 118 W, 6th P.M., and running thence North179 feet;
thence West 85 feet; thence South 179 feet; thence East 85
feet, to the point of beginning.
SUBJECT TO all easements, exceptions, restrictions,
reservations and rights of way of sight or record.
That the undersigned affiant is the same identical person as Lola Frances
Roth, named as one of the grantees in the above-described Warranty Deed, that
she and Edward James Roth were husband and wife at the time of the execution
and recording of the Warranty Deed described above, and that as the surviving
co-tenant and spouse of Edward James Roth, named in said conveyance, the
undersigned, Lola Frances Roth, became on December 6, 1996, the date of the
death of the aforementioned decedent, the owner of the land or the owner of any
interest of Edward James Roth in the land described in the foregoing, subject to
any then existing liens and encumbrances.
071.2
DATED this ? c/ day of March, 2005
couaty o¢ /~1~.~ st.t. of ((
u.~,. ~ w~.~ ii Lola Frances Roth
~~~M Commlm~llofl Ex Ire~ Mey 26 2006
Subscribed and sworn to by Lola Frances Roth. before me this
of March, 2005.
Witness my hand and official seal.
Iq day
My commission expires: t,~ 01.,~, ,A oo £
FOR
INSTRUC'rIONS
SEE
HANOeOOK
sTATE OF WYOMING
: DEPARTMENT OF HEALTH
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
qTATE FILE NUMeER
EDWARD
JAMES ROTH MALE ECEMBER 6, 1996
338-14-6809 I~ 1~ 1~ I~, /j ' ' '
.~ ~ o~ r~ ~ ~ ~UARY 16, 19 21
~ F~mv ~E ~ ~ ~,,,~. ~. ,~ ~ ~ LINCOLN
LL NOIS ~ I ~RRIED LOLA LOONEY
~ ..... ~ Y~S [ MEC~NIC ' ~AIRC~FT & AUTOMOBILE
~ ~"°~"' ~ : ' :' I w~T~ ~,,~,,, ....
NO
' JOHN ~ EDWARD , ROTH CECILA
PUSCAR
MAILING ADDRESS STREET OR R.F.D, I*aJ_ .Mi~R : CITY OR TOWN ~STATE ZiP CODE
P. O, BOX 101 : ' sMOOT WYOMING 83126
~ IDECEMBER 11,199[ 'SHOOT CF.~RTER¥ ' ' SM0r~m
-I -
NOEL STIBOR MD. :; ii0':'HOSPITAL' ~NE :XFTO~; ~0MiNG 83110
14920
This is a true and exact reproduction of the document on file in the off ce of Vital
Records Services, Cheyenne, Wyoming.
.............. t v~d unless prepared on paper with .... gravedborderdisplay?.~.~'-[",'::.':;[<'sealandsignat .... rthe
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Deputy State Registrar
Deputy State Registrar.