Wallace Affidavit of Continuous and Uninterrupted Marriage INSTR 5572730 OR 5522 PG 2870
RECORDED 6/18/2018 1:32 PM PAGES 3
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
PROPERTYFOENTtFtCATtONNUMBER 3995972O®4 COLLIER COUNTY FLORIDA
REC$27.00 INDX$2.00
AFFIDAVIT OF CONTINUOUS AND UNINTERRUPTED MARRIAGE
Before me, the undersigned authority, personally appeared JANET L. WALLACE, "Affiant" who was
sworn and say:
1. Affiant is one of three owners of the property described on Exhibit "A" attached hereto and
incorporated by reference.
2. Title to the property described on Exhibit "A" was granted to Earl V. Konkler and Marilyn Konkler,
his wife, on November 8, 1976 by Warranty Deed recorded in the Public Records of Collier
County in Official Records Book 671, Page 1377.
3, Title to the property described on Exhibit "A" was then granted to Janet L. Wallace, Kevin L.
Konkler, and Linda K. Frauendorfer formerly known as Linda K. Blake, all as tenants in common,
on February 24, 2005 by Order of Summary Administration as recorded in the Public Records of
Collier County in Official Records Book 3743, Page 595.
4. Earl V. Konkler and Marilyn Konkler were married continuously and uninterrupted from
/if) /q-1/3 (date of marriage) through and the date of Earl V. Konklers death on
c - /`�`;S' . t
5. Affiant is one of the surviving daughters of Marilyn Konkler. D e �n C e i * f c ti 4 e
Further Affiants Sayeth Naught. h tk `` Ity t
NET L. WALLACE
STATE OF Off
f
COUNTY OF Fai n
Sworn to and subscribed before me this day of /nay 2018, by JANET L.
WALLACE, who has produced D f- i iete.c/lc. as identification
and who did take an oath.
(affix notarial seal) / ;._'Ai_. t Al ,
(Sign=ure of Nota Public)
1C�"s SHERRY A.LOWERY (Print Name of No-ry Public)
*_ Notary Public,State of Ohio NOTARY PUBLIC
• • : My Comm.Expires 12/13/2020 Serial/Commission Number)c 4 L,
. o� ,� Recorded in Franklin County My Commission Expires /01--//3/;?-t).3-e)
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t ,ITEINMARGIN a 3J DIVISION OF VITAL STATISTICS
RESERVED FOR Roe,DIM No. Stan File No.
ODH DATA CODING Primary Reg.Dist.No. a .5l01 CERTIFICATE OF DEATH Registrar's No. S 7
a.
DECEDENT-NAME Pint Middle Lose SEX DATE OF DEATH(Mo..Dry,Year)
b' 1. Earl V. KONKLER 2.Male ,;Aug. 1, 1985
t' RACE-Ie.g.,Whlte,Eleck,Amer1• AGE-Lett Birthday UNDER t YEAR UNDER 1 DAY DATE OF BIRTH(Mo.,Day,Yr,J COUNTY OF DEATH
S d can Indian,etc.)(Specify) (Years) Moy. 1 Days Hours I Mint. ys
t4, White 5.. f 5b. I Sc. I B. Oat. 15 1925 leF'r$nklin
•-N
f'. CITY,VILLAGE OR LOCATION OF DEATH HOSPITAL OR OTHER INSTITUTIOName(If not in.either,give street num
and beq IF HOSP.OR INST.Inc/Icel./DOA.
OP/Emer.Roo.,Inpetlent(Specify)
Lj`' M. Columbu- l. Mt. Carmel Medical Center Td. Infatient
STATE OF BIRTH((f not in U.S.A.,name CITIZEN OF WHAT COUNTRY ORIGIN OR DESCENT Meilen,Mexican,Getman,English,Cuban, SOCIAL SECURITY NUMBER
13E>4EOENli>`
co"
n"y) Puerto Rican.etc.)(Speetfyl
B..
0111.9 8b- U,; oAterican
USUAL RESIDENCE WAS DECEASED EV ER IN U.S.ARMED FORCES? MARRIED,NEVER MARRIED, SURVIVING SPOUSE(If wife,give maiden nom<)
WHERE DECEASED (Yes,no,or unknown; (If yes,give dater of service) WIDOWED,DIVORCED(Specify) T�
LIVED.IF DEATH it.Yes. 12 30 42-1 22 46 12e. Married 12b.MarilyJ
n J. (Harrison)
OCCURREDIN
INSTITUTION,GIVE USUAL OCCUPATION(Dive kind of work done daring mon of working life,even if retired) KIND OF BUSINESS OR INDUSTRY
RESIDENCE BEFORE
ADMISSION 135Associate of Ohio Steak & Barbecue "0. Iib•
RESIDENCE-STATE COUNTY CITY.VILLAGE OR LOCATION STREET AND NUMBER INSIDE CITY LIMITS
(Specify Yes or No/
14.. Ohio 14b.Franklin 14,,Grove Cit T.d.3214 Zuber Rd. ,.a, No,
FATHER-NAME First Middle Lott MOTHER-MAIDEN NAME First Middle Last
,T1' a0.. ,5. Leo Konkler 16. Margaret (Kline)
g, 'NFORMANT-NAME(Type or POlnr) MAILING ADDRESS )STREET OR R.F.0.No.) ICITY OR TOWN) (STATE) (TIP)
,70Mrs. Marilyn J. Konkler tib. 3214 Zuber Rd. Grove City, Ohio 43123
Z
I. APPROXIM r.TE INTERVAL
PART I, DEATH WAS CAUSED BY: [ENTER ONLY ONE CAUSE P •LINE FOR(a),(b) W
,ANO(c)) BETEEN r r!.ET AND DEATH
f„ I.
< k 1:411111111r IMMEDIATE CAUSE I.) ``t /4 'i''a -.I' Irrailler
{ rs�`
rx 1. DUE TO,OR AS A SEaUENCE OF: e"--
0,-
a
in. Conditions,(/any,which ibl • 1 / 1 (941-44,9,61-14.4 Illrefi ----
gave rite to Immediate a' -
�5 /
rause,stating the under- DUE TO,OR AS A CO -f NCfi QF, Or ..
Y �e��llE�IbF�� tying rause tali ".ww• / lL}.I�
': ( Id
r "`� PART It.OTHER SIGNIFICANT CONDITIONS:Conditions contrthurtng to death hurt not related to cause given to Pan((a). AUTOPSY WAS CASE REFERRED TO CORONER
D (Yes or not (Specify Yet or No)
D
rx• a. I9a. 19b.
eii ACC.,SUICIDE,:HOM„UNOET„ DATE OF INJURY HOUR HOW INJURY OCCURR ED(Enter nano?of injury In Fortier Yen it,!test 18)
o. OR PENDING INVEST.(Specify) (Month.Day,Year)
P. 20a. 20b. 20c, M 20d,
INJURY AT WORK PLACE OF INJURY Ar borne,feats,street,factory,office LOCATION (Street or R.F.O.no.,city or village,stair.tip) -
o. (Specify ye;or no) bldg.,etc.(Specify)
r. 20e. 201, 200.
s To be Complex.:by A TENDING PHYSICIAN OnIy To be Completed by CORONER Only
21a.To the best of my knowled, •cath or.ed at the time,dele a •01,e.and due to the couseitl 22a.On the basil of examination and/or investigation.in my opinion deelS occurred et the time,dose
I. stated. ,l^ and place and due to the causelsl stated.
(Signature and Title) - t rit' •a"/ (Signature and Title)
a.
DATE SIGNED(Mo say.Ye. H : DEATH DATE SIGNED(Mo.,Day,Year) HOUR OF DEATH
IPi� r
ER: ,4 '221b. is 21c, V_ M 22b, 22c. M
PRONOUNCED DEAD(Mo.,Day,Tear) PRONOUNCED DEAD Noor)
Aim /Ve .Jy f ^ / -”,�A9c /
224.ON 22e.AT _.......M
NAME AND AD.'ES. . CERTIFIER IPHYSICI AN OR CORONER)(Type or Print) (Street or R.FD no.,city or vitiate,state,rip)
20. • 7 , 6 (G li 4, fa' fr. �C/'v-,..,.�. C/..") ,, q._..-tt J/2,,,,�BURIAL,CREMATION,DATE NAME OF CEMETERY OR CREMATORY LOCATION j (City,village,or county)(State)
OTHER(SPertfty1 Aug.3,1955 Concord Cemetery .d. Grove City , Ohio
2.a,auriai 24b. 24c. DI
NAME OF EMBALMERy�/��/ /�/J/[ Yet - /T-/ILICC.2 tN,o`) FUNERAL DIR .OR'S SI TURE
ILIC.No.)//
<Q).� I3u�a,1I025. Gi�t,Y IA !"k?�/ t ' / 26. ,)f �r c'" i.•�
FUNERAL FIRM 4110 ADDRESS (STREET NO.! ICITY{ {STATE! (ZIPI
i ,�22 Schoedinger Grove City Chapel, 3920 Broadwa , Grove City, Ohio 4312
¢ DATE REC'O BY REGISTRAR'S.SIGNATURE DATE PERMIT ISSUED SIGNATURE OF PERSON ISSUING PERMIT DIST,No.
LOCAL REG, n / /fti28.
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THIS IS A COPY OF THE OFFICIAL CERTIFICATE
FILED AT THE COLUMBUS DEPARTMENT OF
HEALTH No...-6.%.".(E4(........ , .
REGISTRAR DISTRICT #25
• /a „,L,, i74/. j .
,
ANG Q 5 INS
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EXHIBIT "A"
THE WEST SEVENTY-FIVE (75') FEET OF THE WEST ONE HUNDRED FIFTY (150')
FEET OF TRACT 80, GOLDEN GATE ESTATES, UNIT NO, 65, ACCORDING TO
THE PLAT THEREOF AS RECORDED IN PLAT BOOK 5, PAGE 88 OF THE PUBLIC
RECORDS OF COLLIER COUNTY. FLORIDA.
PROPERTY IDENTIFICATION NUMBER: 39959720004
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