HomeMy WebLinkAbout907915,_ 00709
Affidavit of Survivorship
I, Evelyn B. Fay, being of lawful age and duly sworn according to law,
upon my oath, depose and state:
That under the date of May 25, 2000, for valuable consideration, Colin M.
Fay and Evelyn B. Fay, husband and wife, by deed of that date, which deed was
duly filed of record in the Office of the Lincoln County Clerk, on June 5, 2000, in
Book 446 of Photostatic Records on Page 600 conveyed to Colin M. Fay and
Evelyn B. Fay, husband and wife, as tenants by the entireties, the following
described property to-wit:
Lot 22, Star Valley Ranch Plat 7, LincOln County, Wyoming, as
described on the official plat thereof
/7.-
That by reason of said conveyance aforesaid, the said Colin M. Fay and
Evelyn B. Fay became the owners of said real property as tenants by the
entireties, and title thereto vested in them continuously from the date of
conveyance described in said deed to the date of death of Colin M. Fay on the
21st day of October, 2000. That by reason of and upon the death of Colin M.
Fay, title to the above described real property vested absolutely in Evelyn B. Fay.
Affiant avers and certifies that Colin M. Fay, is the identical party named
with Evelyn B. Fay in the aforementioned deed whose 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 of Death of said
decedent, duly certified by the public authority in which said death certificate is a
matter of record.
Dated this
7 dayof /E~.~.- ,2005.
RECEIVED 4~26~2005 at 2:10 PM
RECEIVING # 907915
BOOK: 583 PAGE: 709
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, VVY
Evelyn(/B. Fay
State
of
)ss.
/
County of /--I'~ d_~o//.,,_ )
Subscribed and sworn to before me, a notsry public in and for said County
and State, by Evelyn B. Fay, this ~ day of /Z)-l/5 /,.- ,' / ,2005.
WITNESS my hand and official seal.
MY COMMISSION iXPIRES
Notary Public
My Commission Expires:
CERTIFIED ABSTRACT OF
FULL NAME OF DECEASED COLIN MACFIE FAY.
DATE OF DEATR .... ::.OCTOBER 21, 2000
DATE OF BIRTH JULY 17, 1930
MOTHER' S NAME ~L%RGARET HARMON
FATHER'S NAME 'WALLACE M FAY ":-
PLACE OF DEATH 'UNITY, NEW HAMpsHIRE ':': '
MARITAL STATUS ~L~RR I ED
SPOUSE. : hi ". .... !:'~ EVELYN BROWN
SOCIAL SECURITY NUMBER '......::'008-18-5:882
RBS-IDENCE THAYNE, WYOMING
PLACE: OF DI'SPOSITI'0N "CLARF_,MONT cREM~Toi~IUI~:
FINAL PLACE'OF DISP~SIT{iO HILL. CEMETERY, ~HELBURNE
DATE OF DISPOSITION OCTOBER 24, 2000
MANNER DP DEATH: NATURAL
CAUSE OF'DEATH
)SCLEROTIC)
a PNEUMONIA - HYPOSTATIC - BIBASILAR
b DEMENTIA (SEVERE); MULTI-INFARCT
OTHER SIGNIEICANT CONDITIONS
CORONARY ARTERY DISEASE /
2000007694 ....
:.::'"' 'F I LE "DATE
SEX MALE
VERMONT
!OCTOBER 24, 2000
1 WEEK
5 YRS
DESCRIBE HOW INJURY OCCURRED
DATE/TIME OFINJURY ':' .:'"':'.:. ':i: 'i!ii
PLACE OF INJURY :' ':
LOCATION OF INJURY
NAMEANDADDRESS OF CERTIFIER
STEPHEN B MOORE MD,
f
03743..
MARGINAL NOTES
9000.t0
I HEREBY CERTIFY THAT THIS IS A TRUE ABSTRAd:r"ISSUED FR0'M THE OFFIC'IAL RECORDS ON FILE AT TH S
OFFICE.
DATE ISSUED: April 14::~ 2005 STATE CITY/TOWN OF: C~ONT '
Ibis cody uol valid un{ess oreoared ou e~raved border disDlsyiu~ seal aud
R shall be unlawful ~o~ asyoue ~0 reproduce lbis.cer~ fica~e o~he~ than local or S~a~e
............................