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Affidavit of Survivorship
Peggy L. Ohlson, being of lawful age and duly sworn according to law, upon my
oath, depose and state:
That under the date of November 12, 1997, for valuable consideration, C. G.
Bennett, Inc., by deed of that date, which deed was duly filed of record in the Office of
the Lincoln County Clerk, on November 18, 1997, in Book 404PR, Page 289, conveyed
to Gary L. Nordenstrum and Peggy L. Ohlson, the following described land, to-wit:
Lot 43, Unit C-2 Commissary Ranch Subdivision, Lincoln County, Wyoming
That by reason of said conveyance aforesaid, the said Gary L. Nordenstrum and
Peggy L. Ohlson, husband and wife, became the owners of said real property. Gary's last
name was misspelled as Nordenstrym on the aforementioned deed. The correct spelling
should have been Nordenstrom. Title thereto vested in them continuously from the date
of said conveyance to the date of death of Gary L. Nordenstrom, on the 25th day of
March, 2007. That by reason of and upon the death of Gary L. Nordenstrom, and
pursuant to his Last Will and Testament, title to the above described real property vested
absolutely in Peggy L. Ohlson.
That under the date of September 3, 2002, for valuable consideration, John R.
Griffiths and Connie Griffiths, husband and wife, by deed of that date, which deed was
duly filed of record in the Office of the Lincoln County Clerk, on September 5, 2002, in
Book 498PR, Page 454, conveyed to Gary L. Nordenstrom and Peggy L. Ohlson,
husband and wife, the following described land, to-wit:
Lot 44, Unit C-2 Commissary Ranch Subdivision, Lincoln County, Wyoming
That by reason of said conveyance aforesaid, the said Gary L. Nordenstrom and
Peggy L. Ohlson, husband and wife, became the owners of said real property. Title
thereto vested in them continuously from the date of said conveyance to the date of
death of Gary L. Nordenstrom, on the 25th day of March, 2007. That by reason of and
upon the death of Gary L. Nordenstrom, and pursuant to his Last Will and Testament,
title to the above described real property vested absolutely in Peggy L. Ohlson, his wife.
Affiant avers and certifies that Gary L. Nordenstrom is the identical party named
with Peggy L. Ohlson in the aforementioned deeds, whose death terminated his interest,
title and estate in said real property; and Affiant attaches hereto and makes a part of this
affidavit, a copy of the Official Certificate of Death of said decedent, duly certified by the
public authority in which said death certificate is a matter of record, as well as his Last
Will and Testament. .
Dated this /1 day of ff' 2007.
State of \JiPl b )
\1\ I I \1\1\ V ) ss.
Countyof~ )
SubsenDed and sworn to before me, a nJOfgpubliC in and for said County and
State, by Peggy L. Ohlson, this -t:1- day of . .' 2007.
WITNESS my hand and official seal.
RECEIVED 7/19/2007 at 4:25 PM
RECEIVING # 931443
BOOK: 666 PAGE: 365
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
My Commission Expires: r V
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Gary LNordenstrom,'
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OECE:DËNr INFORMATION ...".... ,"
. :..Date.:,ofDeath~, ··;"","Måï-ch :i5;zòO:1'"
·:CitY'~ôfbeath:';.':";" .., Roy;:·~ :;:~i':
,:}'Socià SecUrity Number: '528.;58-6991 :;~;:
~·Datè ofBirth:.,:Oëtober::28,194!?,
"<Sex:·::¡;':Yi:U"":"iò,, . Male j
.... Ml:irital Status:;::',.: MarrlècL;;·,;:
. Us~a(Ocëupatiö~: """'. Cierica!" ·i:.\ . ....
'. .Ed¡jc~tiðh: ;"".:'~:. Hi9.h"S·shoolor GED .
. "Fálher's Name:-·;.. .' . ..' .... Wallacep N.ord~nstrom
;;:.'''p'.lape,:qf;Deatþ"Typ.e: H.olTÌe",,"'·;'" '.".'" '..
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. Time of Death: .
County of Death: .
Age: ...
Place of Birth:
." Armed Services:
Spouse's Name:
Industry/Business:
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,} )AT;~;i.Š$,ÜED: . AprH2, 2007
,AMENPMENT,!iIS.TORY::' :'." / '.. .;.
:'''''ú3/30/2ÖÖ7· Oê6~dent Date of Death,Jrom .Q312612007 to' 031251200.7
.:: 04/0212007 Spouse Last Name fròm:;Öhlsen tÓOhlson / I
04Î02l2007 Infòrmant Låst Nål1J.å.from~OI:¡lsèn.tÖ Ohlson ...... . ... .
i~~04/02liö0'7iSpòuse Last Name from Ohlson to Crowley . .... ., . ..... . . . .. .'''. . ..
.. . ........ ,This .Is an.exàct t!Ìpr.o :ljjctlon of the document registered In the StateOfflc~..ofVltal.Stâtlstl.êli..;:>
. ..,.Ji.... .. .. Security featur.es oUhls official dOcument Include: Intaglio Border, V Be R Imlige~; Int(),P cyclolds,
ultra violet fibers anti. hologram Image of a hawk over the word valid. This docur'nentdlsplays t/:18
. date, seal and..lgnature ()f the State Registrar and the CountylDlstrlëtHeälth.Offlcei'.··..· . '.' '.
Updided Utah State Seal replaces hawk over valid for authentlclty.<"..·.,~··: ;;.7\~",
~~.~} ...... ..... ·11U1.1~11111 (:ft1.tfJYf!..~.
Barry E. Nangle, State Registrar . * 0 6 1.3: 8 3 72 5 * DlrectorlHealth Officer .:.
Office of Vital StatI8t1.~~ .. . County~.I.$ttlctl:fealthbeþartmen,t~:
if ~ ~-, " t
AFFIDAVIT FOR CORRECTION
This is a legal document. Complete in black 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 bý'affidavit. An item on the bi~h or death certificate may be corr~cted by
affidavit only once; a court order will be required for subsequent corrections. -
There is no processing fee for affidavits registered within one year of the date of the event. A~er one year frqm the date of the event,/there is a
fee for filing the affidavit which includes one replacement copy. Affidavit~ completed within 90 days of issuance may be given credit for monies
'previously paid. (Multiple copies may require an additional fee) \
PLEASE RETURN ALL COPIES WITH ONE COMPLETED 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
0003ti·¡
BIRTH CERTIFICATES
1. List the facts exactly as stated on the reverse side. Opposite each item, correct the information as it should have been stated at the time of the birth.
2. Who mav sian the affidavit for corrections: If the person listed on the record is under 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, ùn)ess 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 surname from that listed on the record until the child's fi~t birthday without proofs. The first, andlor middlè name can be
corrected or added without proofs until the child's sixth birthday.
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. SO(11e 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 medical information (Ca~se of Death) may only be corrected by the certifying physician or the Medical Examiner. I
/
LÒ¡CAL FILE NUMBER
o BIRTH
o DEATH
o STILLBIRTH
/
NAME AS 1a. FIRST NAME :1b. MIDDLE NAME :1c. LAST NAME
REPORTED ON I I
REVERSE I I
~. FACTS E~ACTL Y AS STATED ON THE ORIGINAL RECORD 2b, CORRECT INFORMATION
I
STATEMENT OF
CORRECTIONS ,
i
, '
3. \
WHY IS CHANGE I
NECESSARY? -
~
,- 4.
PROOFS USED TO
AMEND RECORD
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. No1ary Public
- 5. SIGNATURE OF WITNESS My Commission expires
OATH OF FIRST
WITNESS 6. DATE SIGNED 17. AGE OF WITNESS 18. DAYTIME TELEPHONE /I OF WITNESS I
<M!.!E BE 18 ( ) \ S
OR OLDER) 9. ADDRESS OF WITNESS (Street, City, State, Zip) E
A
10. RELATIONSHIP TO PERSON IN 1a: Self Parent/Guardian Spouse L.
Funeral Director Informant Other (Specify)
I hereby certify. under penalty of pedury, 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 )02. DATE SIGNED 113. AGE OF WITNESS 11\ DAYTI)ME TELEPHONE (/ OF WITNESS S
(MUST BE 18 i
OR OLDER) 15. ADDRESS OF WITNESS (Street, City, State, Zip) 7 \ E
A '--
16. RELATIONSHIP TO PERSON IN 1a: Self Parènt/Guardian Spouse L "'-
UDOH-OVRS
REV. 0'/06 Funeral Director Informant Other (Specify)
STATE FILE NUMBER
REGISTRARS USE ONLY: Nun¡ber of Certificates Replaced: _ Initials:
Date: _
/
\
AFFIDAVIT FOR CORRECTION
/'
0003f'9 .,
This is a legal document. Complete in black ink and do not alter.
ANY CHANciES 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 registered 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 dàys of issuance may be given credit for monies
previously paid. (Multiple copies may require an additional fee.)
PLEASE RETURN ALL COPIES WITH ONE COMPLETED AFFIDAVIT WITHIN 90 DAYS FOR REPLACEMENT TO:
UTAH DEPT. OF HEALTH, OFFIC~ OF VITAL RECORDS AND STATISTICS, POBOX 141012,
SALT LAKE CITY, UT 84114-1012
BIRTH CERTIFICATES I
1. List the facts exactly as stated on the reverse side. Opposite each item, correct the information as it should have been ~tated at the time of tfue birth. \
2. Who mav sian the affidavit for corrections: If the person listed on the record is under 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 surname from that listed 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 sixt~ birthday. 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 informationÕh a birth certificate.
DEATH CERTIFICATES
1. If corrections to non medical~nformation 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 medical 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 1a. FIRST NAME :1b. MIDDLE NAME : 1 c. LAST NAME
REPORTED ON I I
REVERSE I I
2a. FACTS EXACTLY AS STATED ON THE ORIGINAL RECORD 2b. CORRECT INFORMATION
/
I
/ /
I !
STATEMENT OF
CORRECTIONS
~
-
\ \ I
, ¡
3.
WHY IS CHANGE
NECESSARY?
4.
PROOFS USED TO
AMEND RECORD /'
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
5. SIGNATURE OF WITNESS My Commission expires "
OATH O~FIRST .
WITN SS 6. DATE SIGNED 17. AGE OF WITNESS r ~fYTI~E TELEPHONE # OF WITNESS SI
(MUST'BE 18
OR O~DER) 9. ADD.RESS OF WITNESS (Street, City, State, Zip) E
A
10. RELATIONSHIP TO PERSON IN 1a: ( Self Parent/Guardian Spow~e. L
Funeral Director , Informant Other (Specify)
I hereby certify, under penalty of pedury, 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 &prrect. Notary Public -
11. SIGNATURE OF WITNESS My Commission expires
OATH OF SECOND i \
WITNESS 12. DATE SIGNED 113. AGE OF WITNESS 114. DAYTIME TELEPHONE # OF WITNESS S
(MUST BE 18 (, )
OR OLDER) 15. ADDRESS OF WITNESS (Street, City, State, Ziþ) E
A /
16. RELATIONSHIP TO PERSON IN 1a: Self Parent/Guardian Spouse L )
UDOH-OVRS
REV. 02/06 Funeral Director Informant Other (Specify)
REGISTRARS USE ONLY: Number of Certificates Replaced: _ Initials:.L-- Date:
/'
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£.ftSlItWI££.MVtD fJ!ESrt)l9,1.P9ft
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gary £. !Noráenstrom
I, Gary L. Nordenstrom, a resident of the State of Utah, County of Weber,
and City of Roy; and being of sound mind, do hereby make, publish and declare
this to be my Last Will and Testament, thereby, revoking and making null and
void any and all other Last Wills and Testaments and/ or Codicils to Last Wills
and Testaments heretofore made by me. All references herein to this Will shall
be construed as referring to this Last Will and Testament only.
FAMILY CLAUSE
At the time of executing this Last Will and Testament, I am married to
Peggy L. Ohlson. The names of my children are listed below. If I do not leave
any property to any of my children, my failure to do so is intentional.
Michael Nordenstrom
Michelle Beaver
RESIDENCY CLAUSE
Having in mind the possibility that I may temporarily reside outside of, or
simply be absent from the State of Utah, County of Weber, and City of Roy, at
the time of my death, I elect and hereby declare that this Will and each and every
disposition and provision contained herein shall be construed and regulated by
and in accordance with the laws of said State of Utah. It is my desire that this
Will be probated in the State of Utah, my place of domicile, and that the principal
administration of my Estate be made in said State of Utah and that none of the
assets of my Estate which may be found in my place of domicile, be remitted to
any other jurisdiction for administration or distribution.
Page 1 of my Last Will and Testament
1~!b1re1 J2:;Þ
#2071646_DOC
-"/"':;..:-
DEBT CLAUSE
I direct that the executor named pursuant to this Last Will and Testament
review (as soon after my death as practical) all of my just debts and obligations,
including funeral expenses and the expenses incident to my last illness; excepting
those long term debts secured by real or personal property which may be
assumed by the Heir of such property, unless such assumption is prohibited by'
law or upon agreement by the Heir. The executor shall pay these just debts only
after the creditor provides sufficient evidence to support their claim.
My executor shall payout of my gross Estate, as if they were my debts,
and without proration or appointment, all estate and inheritance taxes, by
whatever name called; (including any interest due thereon) becoming payable
because of my death in respect to all property comprising my gross Estate for
death tax purposes, whether or not such property passes under this Last Will
and Testament.
I further direct that if any Heir or Heirs named in this Last Will and
Testament should be indebted to me at the time of my death, and evidence of
such indebtedness is provided or made available to the Executor of my Estate,
then that share of my Estate which I give, devise, and bequeath to any and each
such Heir shall be reduced in value by an a~ount equal to the proven
indebtedness of such Heir Qr Heirs, unless I have specifically provided in this
Last Will and Testament for the forbearance of such debt, or unless such Heir is
the sole Principal Heir.
COMMON DISASTER CLAUSE
In the event my spouse and I shall both die in, or as a result of, a common
accident or disaster, or under such circumstances that the order of our deaths
cannot be established by proof, then I direct that for purposes of this Last Will
and Testament, my spouse shall be deemed to have survived me.
PRINCIPAL DISTRIBUTION CLAUSE
I give, devise, and bequeath to my spouse, Peggy L. Ohlson (my
"Principal Heir"), if my spouse shall survive me, 100% of my gross Estate after
payment of all my just debts, expenses and taxes.
Page 2 of my Last Will and Testament
,~//-7wLl.Æ~ -
( 19nature)
J?1
ALTERNATE PRINCIPAL HEms
In the event that my spouse does not survive me, I give, devise, and
bequeath to the persons named below (my" Alternate Principal Heirs"), if he or
she, whichever the case may be, shall survive me, all of the residue and
remainder of my gross Estate after payment of all my just debts, expenses, taxes
and alternate specific bequests, if any, in the percentages set forth below.
1. Name: Michael Nordenstrom
Relation: Son
Percentage: 331/3%
2 Name: Shane Ohlson
Relation: Stepson
Percentage: 33 1/3%
In case such alternate principal heir does not survive me, I direct
that the share of my Estate which would have been given to such
·;alternate principal heir shall be equally distributed to: Skyler
Gallegos and Sydney Marchant.
3. Name: Misty Ohlson
Relation: Stepdaughter
Percentage: 331/3%
In case such alternate principal heir does not survive me, I direct
that the share of my Estate which would have been given to such
alternate principal heir shall be equally distributed to: Skyler
Gallegos and Sydney Marchant.
Page 3 of my Last Will and Testament
-4~1 h~k
ignature)
_p¡c..-
ALTERNATE SPECIFIC BEQUESTS
In the event that my spouse does not survive me, I give, devise, and
bequeath to the persons named below, if he or she, whichever the case may be,
shall survive me, the following items of property:
1. To my son, Michael Nordenstrom,
I give: My American flag (from Grandpa Nordenstrom's office).
2. To my son, Michael Nordenstrom,
I give: MyoId needle nose (small plane belonging to W.O.), Air Pistol (100
years old belonged to W.O. IS uncle), old crocks and canning bottles,
foreign coin collection, catechism book (my mother's), Police SWAT
photo's, Gary's watches, Sewed pictured from Grandma, and Gary's class
rmg.
3. To my daúghter, Michelle Beaver,
I give: MyoId Hudson Bay blanket (never used).
4. To my friend, Will Cragun,
I give: My Colt M-16.
5. To my friend, Melvin Hollanbaugh,
I give: My Colt Commander ACP pistol.
Page 4 of my Last Will and Testament
1 ~j /z4l~k-
(Signature)
000373
000·374
EXECUTOR APPOINTMENT CLAUSE
(A) I nominate, constitute and appoint my wife, Peggy 1. Ohlson, to be
the Executor of my Estate.
(B) If, for any reason, my first nominee Executor should fail to qualify
or be unable or unwilling to accept or to continue as the Executor of my Estate, I
nominate, constitute and appoint my son, Michael Nordenstrom, to be the
Executor of my Estate. .
(C) If for any reason, all of the nominees designated above in
Paragraphs (A) and (B) should fail to qualify or be unable or unwilling or to
continue as Executor of my Estate, I nominate, constitute and appoint my friend,
Will Cragun, to be the Executor of my Estate.
EXECUTOR POWER OF APPOINTMENT CLAUSE
(A) All directives in this Will that use by reference the word Executor
mean and include any person named herein as my Executor (or personal
representative, as may be defined under state law) and any person who may be
acting in either capacity, at any time. Such person shall have broad and
reasonable discretion under the directives of this my Last Will and Testament
with respect to any property, real or personal, left by or held by me, or acquired
by my Executor on behalf of my Estate.
(B) I wish my Executor to have broad and reasonable discretion in the
administration of my Estate, to have all of the powers permitted to be exercised
by an Executor under state law, and to be able to do everything he or she deems
advisable for the best interest of my Estate and the Heirs thereof, all without the
necessity of court approval or supervision. I direct that my Executor perform all
acts, take all such proceedings, and exercise all such rights and privileges,
although not specifically mentioned in this Will, with relation to any such
property, as if the absolute owner thereof; and in connection therewith, to make,
execute and deliver any instruments, and to enter into any covenants or
agreements binding my Estate or any portion thereof.
Page 5 of my Last Will and Testament
~;( ~J);;L-
ignature)
it-,~~_
(C) No such person named in, or appointed in connection with this
Will in a fiduciary capacity shall be required to file any bond or other security for
the faithful performance of his or her duties as such fiduciary in any jurisdiction;
and if, despite this directive, a bond should be required, I request that it be
accepted without sureties and in a nominal amount.
NON-LIABILITY OF FIDUCIARIES
Any fiduciary, including my Executor and any trustee, who in good faith
endeavor to carry out the provisions of this Last Will and Testament, shall not be
liable to me, my Estate, or my heirs, for any damages or claims arising because of
their actions or inactions based on this Last Will and Testament. My Estate shall
indemnify and hold them harmless.
SAVING CLAUSE
If a court of competent jurisdiction shall at any time invalidate or find
unenforceable any provision of this Will, such invalidation shall not be construed
as invalidating the whole of this Will. All of the remaining provisions shall be
undisturbed as to their legal force and effect. If a court finds that an invalidated
or unenforceable provision would become valid if it is limited, then such
provision shall be deemed to be written, deemed, construed and enforced as so
limited.
Page 6 of my Last Will and Testament
j(t;¡::t,/:f f7~
(Signature)
000375
-vvt.jl't;
IN WITNESS WHEREOF, I, the undersigned Testator, declare that I sign
and execute this instrument on the date written below as my Last Will and
Testament and further declare that I sign it willingly, that I execute it as my free
and voluntary act for the purposes expressed in this document and that I am
eighteen years of age or older, of sound mind and under no constraint or undue
influence.
b~!?~
(SIgna e of Gary L:Nordenstrom)
SSN: S-;J.. g:- ..50- 'b 991
Date: I J r L' IJ ~
Page 7 of my Last Will and Testament
~j ~~~-
SIgnature)
'ot.Þt.·
000377
ATTESTATION CLAUSE
This Last Will and Testament, which has been separately. signed by Gary
1. Nordenstrom, the Testator, was signed, executed and declared by the above
named Testator as his or her Last Will and Testament in the presence of each of
us. We, in the presence of the Testator and each other, under penalty of perjury,
hereby subscribe our names as witnesses to the declaration and execution of the
Last Will and Testament by the Testator, and we declare that, to the best of our
knowledge, said Testator is eighteen years of age or older, of sound mind and
under no constraint or undue influence.
1.
L.-- ----. (-
---........,
- ~
Nitti i& WII-I/ 14fT £"'
(print Name)
(Signature of witness)
Date: 11-1- ð ¿"
5ç.,.J-7 .s ./...ð I;tJ U)
(Address)
,.G ..¡. t¿.+ y fL¿ 6- 7
(City, State, ZIP)
2.~
(l;1/~k~1 J e ¡/.u.. Nt-
(print Name)
Date: !I-I-ÖÞ
~")7 ~2ðSo uJ
(Address)
eo I.' ú+ NO ft 7
(City, tate, ZIP)
3.
!J1/J-/(tnV Z./~ /iss e:;-y
. ,
(prmt Name)
Date: 11-1·- (j ¿..
SIe.). 7 ~. .J. ð!;'-cJ uJ \
(Address)
1ft, l/ 1£1- ¡'tiu" 7
(City, $~te, ZIP)
Page 8 of my Last Will and Testament
~;f þ~~~
i~ture)
STATEMENT OF INTERMENT, CREMATION and WISHES
I, Gary L. Nordenstrom, the undersigned, having previously executed a
Last Will and Testament on the date hereof, hereby state that, in addition to the
directives and bequests set forth in said Last Will and Testament, it is my desire
that my remains be interred in a burial plot.
My further wishes and directives are as follows: I do not want a funeral. I
want to be cremated and my ashes spread (may have to get permission) on
Commissary Ridge, Wyoming.
Dated: 1)-/.... tV r;
.
ACKNOWLEDGMENT
OF NOTARY PUBLIC
State of Utah
County of Weber
On this ~ day of )¿I\,v , 20ð(, , before me, the undersigned Notary
Public, personally appeared Gary L. Nordenstrom, personally known to me (or
proved to me on the basis of satisfactory evidence) to be the individual who
signed the foregoing instrument and acknowledged to me that he or she
executed the same in his or her authorized capacity ,and that by such signature,
the person executed the instrument.
Witness my hand and seal.
Signature of Notary Public: Çfa.Z~· /)11714-;71-/
PA TRfCfA MONSON
NOTARYPUBUC. STAlE OF UTAH
5627 S. 2050W.
ROY, UT8406T
COMM. EXP.08.08.2007
UUU;'l (0
0003ti19
SELF-PROVING AFFIDAVIT
State of Utah
County of Weber
I, Gary L. Nordenstrom, the undersigned Testator, being first duly sworn, do
declare to the undersigned authority that I signed and executed the attached or annexed
instrument as my Last Will and Testament and that I signed it willingly, that I executed
it as my free and voluntary act for the purposes expressed in that document and that at
the time I signed the document I was eighteen years of age or older, of sound mind and
under no constraint or undue influence.
Date: II- ¿- (7 G
.
We, the undersigned witnesses, being first duly sworn, do each declare to the
undersigned authority the following: (1) the Testator declared to each of us that the
attached or annexèd instrument is his or her Last Will and Testament; (2) the Testator
executed the will in our presence; (3) each of us, in the presence of the Testator, signed
the will as witness; and (4) to the best of our knowledge the Testator is eighteen years of
age or older, of sound mind and under no constraint or undue influence.
~.~- -"
--
(Signature of witness)
(Sign . re . witness)
3. J~f\nAn1n 0O-C{¡( AA
(Si;~~~e:S) I
N/éð(t:5 tUltll~.ð£
(print Name)
Þ}1 (e.h~ r / g f/-¡,LN T
(Print Name)
J11~¡(é'N;z..;1Æ (;558 y
(print Name)
1.
2.
Acknowledgement of Notary Public:
Subscribed, sworn and acknowledged to me on this./-d day of ~ ' 20èJ 4-'
by Gary L. Nordenstrom, as Testator, and
and , as
witnesses.
Witness my hand and seal.
Signature of Notary Public: i.·:?ãL~ )17h'1A1~
PATRICIA MONSON
NOTARYPUBUC· STATE OF UTAH
5627 S. 2050 W.
ROY. UT 84067
COMM. EXP. 08·08·2007