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TERMINATION OF DECEDENT'S PROPERTYINTEREST <br /> SE DECEDENTS NAME <br /> NK CK Rm& S ifi,o f)62 <br /> ADDRESS OF DECEDENT AT DATE OF DEATH CRY STATE ZIP <br /> Dgb7gHLie_ \)at M - BIllitkAALU, I s3st <br /> i <br /> SOCIAL SECURT Y NUMBER <br /> —L o ► ► <br /> PRESENTATION OF DEATH CERTIFICATE <br /> I ce 'fy hat I have viewed a certified copy of the decedent's death certificate. <br /> chctbs.b: a 5/,i1, t_ <br /> REGISTER OF DEED'S SIGNATURE DATE <br /> Interest in property is terminated under(please check appropriate statute): Name and return address: <br /> V s. 867.045 which pertains to property in which the decedent was a joint tenant,* I I I Li ocv P4c,L1y <br /> had a vendor's or mortgagee's interest, or had a life estate. '(You must provide a copy <br /> of the document establishing joint tenancy or life estate.) Bu,c-calo ('/ Rte- II L <br /> s. 867.046 which pertains to(1) property of a decedent specified in a marital <br /> property agreement,and also to(2) survivorship marital property. (You must provide 6 Doi y <br /> a copy of the document establishing survivorship marital property.) <br /> 5 is E 71 ric,4-I b <br /> Presentation of recorded document establishing joint tenancy,life estate, PARCEL IDENTIFICATION NUMBER <br /> survivorship marital property,vendor interest,or mortgagee interest in real estate. <br /> This document number is / 71.7 y y C/ ,volume , page of(check one)Records Deeds <br /> This document number is 3 7 Si c--.0 7 ,volume , page of(check one)Records Deeds <br /> Description of the real estate. <br /> Include only the extent of ownership(or vendor or mortgagee's interest)in land at the time of the decedent's death. If 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 tax bill for year immediately preceding <br /> death,if applicable. (See directions.) The legal description of th property and the persons receiving the property are as follows: (If more space is <br /> needed, attach pages.) <br /> See Attached <br /> • <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 property. <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 <br /> conformity with the provisions and limitations of the Wisconsin Statutes. (If more space is needed, attach pages.) <br /> Name and Address o Person Receiv g Property Relationship to Decedent Signature(Notarized) Date <br /> /I LcF ✓� Idor -13 <br /> g Lo 1 y L-e., \)ot tl e R DJ; F 5-3 <br /> This document was drafter i�RY pycillfl f, STATE OF WISCONSIN,County of DA-7u <br /> (print or type name bekw) <br /> c��i6ned and sworn to before me on `) - - I 3 by th: -•ove named person(s). <br /> • n <br /> 1 'PO I' 5, I, st ' Signature of notary or other person a �� p`� <br /> '�' �'"''" autfiorized to administer an oath ��'l�' t'lt.( t 4/ <br /> h (ai'per s.706.06, 706.07) i� //�� <br /> NOTE: SEE DIRECTIONS ON R .'c• - rint or type name C I!J Q ! /-I m � <br /> Ntsconsin Register of Deeds Association Form HT-110(1/2001)r���-\,����\\~` ` 1Q 'n //� <br /> '1516(3/D1> Title Vv Date commission expires l(/ t <br />