HomeMy WebLinkAbout925608
RECEIVED 12/26/2006 at 3:4~. , ..
RECEIVING # 925608
BOOK: 644 PAGE: 591
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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000591
Date: fltv: I Z7Eà=.)
To Lincoln County Clerks Office,
My name is Jerald W. Tovey. I'm a son and co-successor to Renee M. Tovey's Estate.
I have been appointed spokesperson as her personal representative,
The reason for this letter is to notifY you of the death of Renee M. Tovey. She passed
away on Nov. 2ih, 2004 at L.D.S. Hospital, Salt Lake City, Utah.
Under the authority of the Renee M. Tovey Family Trust Fund: (Section 2: Article
7.2), and co-successors to her Last Will and Testimony. We the undersigned are in
majority agreement for the decisions made upon this contract.
At this time we as co-successors are submitting a Quitclaim Deed to place the Star
Valley Ranch Estate, Plat #5, Lot #120, from Renee M. Tovey into Terence S. Tovey's
name. I'm also sending along a copy of Renee M. Tovey's Will to help out with any
question you may have. Please call me at Home: (801) 453-1441 or Cell (801) 674-6531
if you have any questions.
Co-successor: Terence S. To
Spokesperson/Co-successor: Jerald W. Tovey
Co-successor: Brenda L. Ford
Co-successor: Michelle Tovey
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Notary Public:
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DATE I$SUED:
NOV! 3 0 2006
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This is an exaèt reproduction of the document registered in the S,ate Office of Vital,Stätistics: ~
Security featúres oUhis official document include: Intaglio Border,V & R images in top cyclolds,
uitravioietflbers and hologram image of a hawk over the word valid. This docul11,ent dlspl!'lYs the
date,seai anct signature of the State Registrar of Vital Statistics. ' , "
Updated Utah State Seal replaces hawk over valid for authenticity,
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Barry E. Nangle
State. Registrár
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*06~0400~4*
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UTAH DEPARTM~NT6F HÊÂL.TH
, Office of Vital Records &,Statistics
'Salt Lake City, Ut¡¡h ""I ' ,'"
Q925G08 AFFIDAVIT FOR CORRECTION OOO!;S3
\ This is a legal document. Complete irlblack ink and do not alter. ,
ANY CHANGES MADE BELOW VOID THIS CERTIFICATE. A NEW CERTIFICATE MUST BE ISSUED TO VALIDATE CHANGES,
All vital records are registered as received, Corrections must be made by affidavit. .An item on the birth or death certificate may be corrected by
affidavit only once; a court order will be required for subsequent corrections.
There is no processing fee for affidavits registéred within one year of the date of the event. After one year from the date of the event. there is a
fee for filing the affidavit which includes one replacement copy. Affidavits~completed within 90 days of issuance may be given credit for monies
previously paid, (Multiple coptes may require an additional fee,) I
PLEASE RETURN ALL COPIES WITH ONE COMPLET~ AFFIDAVIT WITHIN 90 DAYS FOR REPLACEMENT TO:
UTAH DEPT, OF HEALTH, OFFICE OF VITAL RECORDS AND STATISTICS, POBOX 141012,
/ SALT LAKE CITY, UT 84114-1012 /
BIRTH CERTIFIÇl\TES ) \ /
1. List the facts exactly as stated on the reverse side. Opposite each item. correct ¡he information as it should have been stated at the time of th~ birth. \
2. Who mav sian the affidavit for corrections: If the person listed on the record is Ulider 18. both parents listed on the record, If the person listed on the record is
18 he/she must sign as one of the witnesses. unless mentally incompetent or physically incapacitated. Parents or other older relatives are preferred witnesses
for the second signature. If no father is listed on the record. an older relative of the mother of legal age may sign. The signatures must be notarized. .
3. The parent(s) may add or correct the surnanle from thállisted on the record until the child's first birthday without proofs. The first. and/or middle name can be
corrected or added without proofs until the child's sixth birthday. I I
4. If the child is under the age of six and there is no father listed on the record. the child's surname may be corrected to match the mother's maiden name without
documentation. - "
5. Minor corrections in spelling or parents' information may be corrected anytime, Some corrections may require documentary proof.
6. This affidavit cannot be used to add a father to or correct medical information on a birth certificate.
DEATH CERTIFICATES
1, If corrections to non medical information are not being made by the Funeral Home. the Informant MUST sign as a witness along with an older relative of the
decedent..or another person who is knowledgeable of the facts.
2. The medicàl information (Cause of Death) may only be corrected by the certifying physician or the Medical Examiner.
LOCAL FILE NUMBER
o BIRTH
o DEATH
o STILLBIRTH
STATE FILE NUMBER
NAME AS la, FIRST NAME :lb. MIDDLE NAME :lc, LAST NAME
REPORTED ON , I
REVERSE , ,
2a. FACTS EXACTLY AS STATED ON THE ORIGINAL RECORD 2b, CORRECT INFORMATION
\
,
STATEMENT OF
CORRECTIONS
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. ,,-
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3. ;
WHY IS CHANGE
NECESSARY? '- --
I. (
4. "
PROOFS USED TO I
AMEND RECORD
I hereby certify, under penalty of peljury, that I have perspnal knowledge of the Subscribed & Sworn to before me this _ day of 20_
above facts and that the information given is true and correct. Notary Public
5. SIGNATURE OF WITNESS My Commission expires
OATH OF FIRST ""
WITNESS 6. DATE SIGNED r AGE OF WITNESS r ~AYTI~E TELEPHONE # OF WITNESS
(MUST BE 18 S
OR OLDER) 9. ADDRESS OF WI,NESS (Street, C(ty. State, Zip) E
A
10. RELATIONSHIP TO PERSON IN la: Self Parent/Guardian Spouse L
Funeral Director Informant Other (Specify)
I hereby certify. under penalty of perjury. that I have personal knowledge of the Subscribed & Sworn to before me this _ day of 20_
above facts and that the information given is true and correct. Notary Public
11. SIGNATURE OF WITNESS My Commission expires
OATH OF SECOND -'
WITNESS 12. DATE SIGNED 113. AGE OF WITNESS /14i DAYT~)ME TELEPHONE # OF WITNESS S \
(MUST BE 18
OR OLDER) 15, ADDRESS OF WITNESS (Street, City. State. Zip) E
A
16. RELATIONSHIP TO PERSON IN la: Self Parent/Guardian Spouse I L
UDOH-OVRS
REV, 02/06 Funeral Director Informant Other (Specify)
J ' , ~'- . . \
REGISTRARS USE ONLY. Number of Certificates Replaced. _ Initials, _ Date.