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• <br /> • <br /> 0 DANE COUNTY <br /> TERMINATION OF DECEDENT'S REGISTER OF DEEDS <br /> PROPERTY INTEREST DOCUMENT # <br /> DECEDENTS NAME <br /> N .yam TR �; ` 1 �� 01/22/2003 @3:29:1 SGM <br /> ADORR SS or DECEDENT DATE OF DEATH, C���~CIiT�V� t �STrAT�E-�~ •� 21P Trans. Fee: <br /> L(�/`ti� QLT S T1( sit ar ��#F U �552_S <br /> Exempt F e s <br /> Rec. Feel 25.00 <br /> GATE OF DEATH Pages: 12 <br /> 2-C.)0 Z. <br /> PRESENTATION OF DEATH CERTIFICATE <br /> I certify that I have viewed a certified copy of the decedent's death certificate. <br /> l ct-- 0/--02 a-0 3 . <br /> REGISTER OFD ED'S SIGNATURE DATE 0 0 4 7 8 7 <br /> Interest In property Is terminated under(please check appropriate statute): Recording area <br /> • <br /> Name and return address: <br /> s. 867.045 which pertains to property in which the decedent was a joint tenant,' Y�� 1�-yI <br /> � <br /> had a vendor's or mortgagee's interest,or had a life estate.'(You must provide a copy �/ . l,T <br /> of the document establishing joint tenancy or life estate.) e.i� s.867.046 which pertains to(1)property of a decedent specified in a marital 0 ���B_ • <br /> �) <br /> property agreement, and also to(2)survivorship marital property. (You must provide QJ �- S3S ( <br /> a copy of the document establishing survivorship marital property.) <br /> Presentation of recorded document establishing joint tenancy,life estate, SEE <br /> survivorship marital property,vendor interest,or mortgages Interest In real estate. PARCEL IDENTIFICATION NUMBER <br /> This document number is 3561 Q.') 09 •volume _. •page of (check one)Records lit Deeds <br /> This document number is 34. O {.c, 0 ,volume •page of (check one)Records Deeds . <br /> This document number is ,volume ,page of (check one)Records Deeds . <br /> Description of the real estate. <br /> /Itclude only the extent of ownership for vendor or mortgagees Interest)in land a(the time of the deciedentb death,ll the extent of land is exactly <br /> the same as on the document,a copy of that document may be attached to describe the real estate.Attach fax bill for year immediately preceding <br /> death,if applicable. (See directions.) The legal description of the property and the persons receiving the property are as follows: (If more space i <br /> needed, attach pages.) <br /> ` <br /> 0 See Attached <br /> Description of personal property(if any)being transferred. <br /> You may list savings accounts, checking accounts and securities on attached pages. Indicate person(s)receiving properly. <br /> DECLARATION: I(We)declare that this document is.to the best of my(our)knowledge and belief,true,correct and complete and is in confor- <br /> mity with the provisions and limitations of the Wisconsin Statutes. (If more space is needed, attach pages.) <br /> Name and Addresso-f� s�Person,Receiving Property Relationship to Decadent Signature(Notarized) Date <br /> LYE ‘AX- S35Z I " <br /> •- WINCONSIN,County of d <br /> This document was drafted by: <br /> (print or type name below) •ind • fore me o - <br /> *. ig��t IMr lta ,4•ther person II� i_ / t f//' <br /> DELEgaillgi ist. • <br /> it ∎`F iuthaied�tred ran oath „" ) 4►_ I ,, t <br /> tE Eas PY/b LCI 6r -• ' �/ <br /> t~`' a' C.�i t l <br /> I NOTE: SEE DIRECTIONS ON REVERSE SIDE. fry;•Pvtnt.pr type,o a`4�" : / I L _ MID <br /> '-'2.1' <br /> itle..; .�.,^;:;,' Date commission expires •7'Z 3 aQ q <br /> Wsoon.in Rpyt. of Dowels A$OdMton Form HT-110(1Inn) -:"..;,-,;.;,: s <br /> It�' p ! <br /> 21S-16 lY97) r <br /> � <br /> S <br />