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AFFIDAVIT OF SURVIVORSHIP
STATE OF WYOMING )
COUNTY OF NATRONA )
RECEIVED 5/12/2005 at 11:18 AM
RECEiViNG # 908363
BOOK: 585 PAGE: 175
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, VVY
A. Thomas Graham, Jr., being first duly sworn, states as follows:
1. Affiant is the surviving spouse and the surviving tenant of a tenancy by the
entireties with respect to the Decedent hereinafter referred to; therefore, Affiant has an interest in
the real estate which is the subject matter of this Affidavit.
2. Affiant states that Joan Lenore Graham, ffk/a Joan Lenore Larsen died at Casper,
Natrona County, Wyoming on June 22, 2004; the facts of said death more fully appear from the
Certificate of Death, duly certified by the State Registrar of Vital Statistics, attached hereto and
by this reference incorporated herein.
3. During the marriage to said Decedent, your Affiant, A. Thomas Graham, Jr., and
his spouse, Joan L. Graham, acquired as husband and wife, certain real property by Warranty
Deed from A. Thomas Graham, Jr. and Joan L. Larsen, k/fda Joan L. Graham, dated May 6,
1991, and recorded in the Office of the County Clerk of Lincoln County, Wyoming on May 8,
1991 in Book 296PR, Page 347, as Instrument Number 732187 of the books and records in said
office, which property is more particularly described as follows:
Lot 54, Unit 10, Star Valley Ranch Subdivision,
Section 31, Township 35 North, Range 118 West,
Lincoln County, Wyoming
4. This Affidavit is filed for the purpose of establishing the fact of the death of the
said Joan Lenore Graham, f/Ida Joan Lenora Larsen, and to make an official record of the
termination of the interests of said Decedent in and to said property pursuant to the provision of
0176
Wyo. Stat. Ann. §2-9-102 (LexisNexis 2004) and to establish sole ownership in the name of thc
undersigned as survivor.
A. Thomas Grah~n, 'Jr.
STATE OF WYOMING )
) SS.
COUNTY OF NATRONA )
and sworn to before me by A. Thomas Graham, Jr. this 09 oc~ day of
,2005.
Witness my hand and official seal.
M :~? '
Notary Public
o os TATE OF.,.WY:O. MING
DEPARTMENT OF HEALTH
STATE OF WYOMING .'""~,
296
. .:':... .i. : DEPARTMENT OI~:HEAETH
LOCALFILE NUMBER CERTIFICATE OF DEATH'
STATE FILE NUMBER
/
'Fer~:ie :'june 22, '200'/ '
I ¢~1 t. I~" I ............
~20 50 8652 September 25~ 1946
Wyom~g
Medical
Center
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O~ES
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This is a True and exact reproduction of the document on file in the office of Vital
DATE'ISSUED: JUL ::~:9 ~:~: ::: ':: : ' ;:'- Luc~da~cC~ffre~: /~
~ Depu~ State Registrar
Thb copy is not v~id u~less prepared o~ p~per with ~ ensrawd border dbplayin¢ thc d~te, sc~t ~d signature oCthc D~u[y State ~c~is[rar