HomeMy WebLinkAbout908483STATE OF WYOMING )
) SS:
COUNTY OF LINCOLN )
RECEIVED 5/17/2005 at 2:01 PM
RECEIVING # 908483
BOOK: 585 PAGE: 493
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMF:RER, WY
JANE A. SMITH, being first duly sworn upon her oath, deposes and states as
follows:
1. On or about the 5`8 day of April, 2005, my husband, RANDALL M.
SMITH, died, as is evidenced by the official certificate of death attached hereto and
incorporated herein by this reference.
2. At the time of his death my husband jointly owned certain real property
with me, said real property being located in the County of Lincoln, State of Wyoming,
and more particularly described as follows:
Beginning at the Northwest Comer of Lot One (1) being a part of the Northeast Quarter
of the Northeast Quarter (NE1/4NE1/4) of Section Four (4), Township Thirty Two (32)
North, Range 119 West of the 6th P. M., Wyoming, and running thence South 255 feet;
thence East 255 feet; thence North 255 feet to the NOrth line of said Lot One (1); thence
West 255 feet to the point of beginning.
TOGETHER with all improvements and appurtenances thereon situate or in anywise
appertaining thereunto.
SUBJECT, HOWEVER, to all reservations, restrictions, exceptions, easements and right-
of-ways of record or in use.
Said real property was originally conveyed to RANDALL M. SMITH and JANE A.
SMITH, husband and wife, as tenants by the entireties, by Warranty Deed dated March 1,
2000, and recorded in the Office of the Lincoln County Clerk and Ex-Officio Register of
Deeds on March 2, 2000, in Book 442 at Page 220.
Jane Smith Affidavit of Survivorship
1 of 2
3. By reason of my husband's death, I am entitled to sole ownership of the
above-mentioned real property.
DATED this !/qd~-day of May, 2005
SUBSCRIBED AND SW_O_R.BM~and acknowledged before me this [} ~'~day of
May, 2005, by JANE A. SMITH.
WITNESS my hand and official seal.
Notary Public
My Commission Expires:
Jane Smith Affidavit of Survivorship
2 of 2
0 0
LOCAL FILE NUMBER CERTIFICATE OF DEATH STATE FILE NUMBER
RANDALL i:: ': M' ::: SMiTH:ii::. :i' ::!!' ':¥:!:: ';iii' 'i:.:::: ""::i! ':"'~ MAL~':;i: APPROX.: APRIL 5, 2005 ' .:
~ pATE OF m~T~ (M~x~r) :'.:..
528-68-4903 I '~' 58 I~ I .... ~ I~. I~,, FEBRU~Y 8, 1947
ACU~NA~ E~ ~lla~ 0val e,
3907 fl~GHNAY 238
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3907 HIGHWAY 238 . ~ : ..... *--','~.'. ; ...... s' ~::~ :: :83~:~ .... . .: · :: · ·
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~RVIN S~H. ~ ;:(;- ~.~ j
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~Cr~,,~ · ~::O~.; : D~.' ..'... ,..,..;,..r, .gAGgg gOC~'~R~Y 1PAtiO' FALLS, ~DAflO
~/~' :i;:? :~? ";i:t '~M-~6?,' 'SCE~AB'::HO~A~'~ ~' ~4 ~AST EOURT~ A~ , AFTON
. '::: ..,.¥ :?::::.::~Li" ~ ~i -'. , CAUSE OF D~TH:~ .... !:?'~-:---- ' --~- ';';:~;,~ ..'; :::. z v;::'. ~:~.: . . ' ~ ,-' ' : :;:- :: ~ :
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This is a true anti exact reproduction of the
Records Services Cheyenne F~.~mirf~ ~ doc~m.~.~t or~ file in the office of Vital
............. "::' ....... :' 4 Lu~i~ldai Mcoaff;~y /'
DATE ISSUED!: i: ::: ii; ii. ,? i:: ..... i!: : Deputy State ,'~egis,rar
This copy is not valid unless prepared on papcr with a,n engraved border displaying the date, seal and signature of the Deputy State Registrar