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AFFIDAVIT OF SURVIVORSHIP
STATE OF CALIFORNIA )
) SS.
COUNTY OF LOS ANGELES )
I, SHIGEKO TACHIKI, being duly sworn under oath, state as follows:
1. Kenneth H. Tachiki has tenancy by the entireties with me in land in Lincoln
County, Wyoming, more particularly described as follows:
Lot Nine (9) in Star Valley Ranch Plat Eight (8) as platted and recorded in the
official records of Lincoln County, Wyoming.
Plat Ten (10) Lot Fifty-Five (55) in Star Valley Ranch, as platted and recorded in
the official records of Lincoln County, Wyoming.
Attached hereto are copies of the Warranty Deeds creating the tenancy by the entireties, recorded
in the Lincoln County, WyOming, land records in Book 197PR at Page 454, on February 15,
1983, as Instrument No. 591775, and in Book 251PR at Page 172, on May 11, 1987, as
Instrument No. 672401.
2. I, Shigeko Tachiki, the surviving spouse of Kenneth Hideshi Tachiki, hereby
certify that Kenneth Hideshi Tachiki died on December 4, 2004. Attached hereto is an original
copy of the Certificate of Death issued for Kenneth Hideshi Tachiki.
3. Pursuant to Wyoming Statutes § 2-9-102, I certify that the tenancy of Kenneth
Hideshi Tachiki has been terminated by his death, and that title to the above-referenced lands are
now in the name of Shigeko Tachiki, a single woman.
DATED this I,,70 day of May, 2005.
RECEIVED 5/18/2005 at 10:41 AM
RECEIVING # 908509
BOOK: 585 PAGE: 590..
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ACKNOWLEDGED, SUBSCRIBED AND SWORN TO before me by SHIGEKO
TACHIKI this I ~-*~ day of May, 2005.
SHIGEKO TACHIKI
WITNESS my hand and official seal.
- ~ Commission # 1367824 ·
. z
~ Notary Pubhc -Califomia ~.
My Commission expires: ~/:z-:~/~,o
NOTARY PUBLIC
TY::OF LOS ANGE
DEPARTMENT OF HEALTH SERVICES
Departmeni q~:Heal
mr;~ior Of h~tth'
This
)splaying seal and signature of Registrar.
'- CERTIFICATE OF DEATH
KENNETU .,: I": ItlDESItI'? -' : [ TACHIKI
cALIFO~IA 21L[:'5'72'i62¢OT~h :; - ~ ~.o ~ ~aalED % 12/04/2004 0135
l
12006 ST~OOD ,DRIgE
LOS ~GELES ' "~'~/?:~" '~J LOS ~GEL~
SHIGEKO TACHIKI. WIFE -h':'":-'~ 12006 S
SHIGEKO
KENSHI ~ '~ UNKNO~
12/10/2004
CR/RES. · ' NOT ~EMBALME~,
~*oSE~.., ....-~ ~TASTATIC
ll2. OTHERSlGNIFIG~TC~DITIONSCO~BUTI~THBUTNgT~[~ NIN~RLY~¢q~U~EGJVEgffi??~ ¢ ~,¢% ',
................ - - - -A81052 ~/07/2004
12/bl/2004 WALLENSTE~N,~ 1250A6TH STREET, SANTA MONICA,
".,,"
s signature in pu~l~i~k: .....
$4.00
.............. (-59o
THIS INDENTURE, made this 1 lth day of_. February ,19}3
by and between LEISURE VALLEY, INC., a Corporation organized and ex~g ~mde~
and by virtue o~ ~he laws of the State o~ NEVADA, duly au~hm~zad to do busine~ ~ the
$~te o~ WYOMING and having i~s principal place ~ busflms~ ~ ~e County of Linco~,
State of Wyoming, the GRANTOR, and KENNETM H. TACHIKI ~ 5~IGEKO
TACMIKI, HUSBAN~ ~ WIFE AS 2OINT TENANTS
of the County of LO5 ANGELES
the GRANTEE, whose address is
, State of CALIFORNIA
12006 STANWOOD DR
LOS ANGELES, CA 900~
WITNESSETH: That the GRANTOR, for and in consideration of 'PEN DOLLARS
($10.00) in hand paid, the receipt whereof is hereby acknowledged, does, by these pres-
en~s, grant, bargain, ~ell, CONVEY AND WARRANT unto the said GRANTEE, all that
ertain tract, lot, piece, and parcel of land situate in the County of l.incoln, State of
Wyoming, hereby releasin'g and waiving all rights under and by virtue of the homestead
exemption laws of the State, to-wit:
LOT NINE (9) IN STAR VALLEY RANCH PLAT EIGHT (g)
AS PLATTED AND RECORDED IN THE OFFICIAL RECORDS
OF LINCOLN COUNTY, WYOMING.
RESERVING THEREFROM all rights, title, and interest in and to any and
all minerals and rights appertaining thereto.
Subject to all declarations of covenants, conditions and resrictions of record.
IN WITNESS WHEREOF, the Oranf~r has caused its corporate seal to be here-
.... '.,u~.to a/Sxed, and these presents to be signed by its duly authorized of~cer, khe day and
:" ' y~ar first' above written.
..,._ S L '
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%~~.__ LEISURE VALLEY, INC.
A Nevada Corpora6on
Pre,id~n~
,.qTATE OF . NEVADA
('OUNTY OF CL______ARK
The foregoing instrument was acknowledged before me by PAUL 3UDD
qnd_ A.LDEN L. STEWART ~_NOIA~y PlISLIC_._
-- day of Fe.~bru_..a_r_y ..... .,
2'd ZG6'0N >~39D OD Ng0DNI9 NU9q: S002'6 'AUN
THIS INDENTURE, made this 7th day of blay ., 19 87 ,
by and between LEISURE VALLEY, INC., a Corporation organized and existing under
and by virtue of the laws of the State of NEVADA, duly authorized to do business in the
State of WYOMING and having its prln¢ipal place of business in the County of Lincoln,
State of Wyoming, the GRANTOR, and_Kennet 1 Iq. Tachiki and .Shigeko Tachiki
a~-Oe-~-t J-e~ n t z
of the County of ---Lo.,~-~ ~r~l. ~ , State of ---Calitnrj~a
thc GRANTEE, whose addres~ is 12r)~r..tv~ '
WITNESSETH: That the ORANTOR, for and in consideration of TEN DOLLARS
($10.00) in hand paid, tl~e receipt whereof is hereby acknowledged, does, by these pres-
ents, gran~, bargain, sell, CONVEy AND. WARRANT un~o tl~e said GRANTEE, all tJm~
certain tract, lot, pJ¢ce~ and parcel of land situate in the County of Lincoln, State of
Wyoming, hereby rdeasing and waiving all rights under and by virtue of the homestead
exemption laws of the State, to-wit:
Plat Ten (10) Lot Fifty-Five (55) in Star Valley Ranch,
as platted and reconded in the Official Records of
Lincoln County, Wyoming.
RESERVING THEREFROM all rights, title, and interest in and to any and
all minerals and rights, appertaining thereto.
Subject to all declarations of covenants, conditions and resrictions of record.
" IN WITNESS WHEREOF,
.... 1,3~.,i'o affixed and ~ese presents the Grantor has caused its corporate seal to be here.
,.-'"' ~ ..... to be si~ned by iN duly authorized o~cer, the day ~d
~,~-" .,.~a~.fi~t above written.
i .' , ". ~ '~
~ : ~ ~... ~.
~, ~".:. ,
s'r~'r~ or ~~ .. _1
LEISURE VALLEY, INC.
A Nevada Corporation
The foregoing instrument was acknowledged be/ore me by Paul Judd
and_._.~A]den L, Ste~tart
this 7th ~ ~. -~.~Lla ~
.Wit--- .. . ~. ~- ~--~.UG~nt'-~A~,-, ~.
m
....
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