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RECEIVING # 942371
BOOK: 705 PAGE: 298
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT ESTABLISHING SUCCESSOR TRUSTEE
STATE OF UTAH
ss.
OOô298
County of Cache
ROBERT L. BROWN being first duly sworn and on
oath deposes and says:
1. He is a resident of pocatello, Idaho over the age
of twenty-one (21) years and is competent by personal
knowledge to state and swear to the things hereinafter
contained.
2. He is the son of CLARA M. BROWN who died in
Logan, Utah on September 29, 2006. The death of CLARA M.
BROWN in evidenced by State of Utah Certificate of death
State File Number 2006012156 a copy of which is attached to
this Affidavit and by this reference made a part hereof.
CLARA MAE CROSSWHITE BROWN named in the attached
certificate of death is one and of the same person as CLARA
M. BROWN who is the subject of this Affidavit.
3. On October 4, 1976 CLARA M. BROWN created the
CLARA M. BROWN Family Intervivos Revocable Trust ("Trust"),
declared herself the Trustee thereof while living and upon
her death, designated Affiant as successor trustee of the
Trust.
4. On October 11, 1977 CLARA M.
Quit Claim Deed to herself as trustee of
following described real property in
Wyoming:
BROWN executed a
the Trust to the
Lincoln County,
Lot 303 in LAKEVIEW ESTATES INCORPORATED, Tract "B", a
subdivision in the South one Half of the Southwest
Quarter of Section 29, Township 37 North, Range 118
West, of the 6th P.M. Wyoming, together with all
improvements thereon. Lincoln County, Wyoming.
Said Quit Claim Deed was recorded October 13, 1977 as
Filing No. 499507 in the records of the County Recorder of
Lincoln County, Wyoming.
000299
5. Said Lot 303 in said subdivision is now Lot 726
Lakeview Estates, 12th Edition.
6. On October 13, 1976 Affiant signed
Acceptance of Trusteeship of the Trust. A
Acceptance is attached to this Affidavit
reference made a part hereof.
in writing an
copy of such
and by this
7. By the express terms of the Trust and by reason
of the death of CLARA M. BROWN and the Acceptance of
Trusteeship signed by Affiant, Affiant has become and now
is the Trustee of the Trust and the owner as Trustee of the
real property described in paragraph 4 of this Affidavit as
renumbered pursuant to paragraph 5 of this Affidavit.
WITNESS my hand this 11th day of September, 2008.
~~-L-'
W (t-h€ÇÇ
l~-fJ- Ã~
Robert L. Brown
SUBSCRIBED AND SWORN to before me on this 11th day of
September, 2008.
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J:\LBH\estate\Brown, Clara\Borwn.Clara Affidavit
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CERTIFICATE OF DEATH
State,File Number: 2006012156
Clara Mae Crosswhite Brown
DECEDENT INFORMATION .....
. Date of Death: Septembér29;2Ö06
'. City of Death: Logan'
Social Security Number:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
. Place of Death Type:
July 5,1923
Female
Divor'éed
Property Manager
High School or GED
Ike Crosswhite·
Nursing Home/Assisted Livi~g
-Time of Death:
County of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business: Rèntal
Residence: Logan, Utah
Mother's Name: Clara Maude McCune
·····FaciHtyor~~cIress: SunshiheTerrace Fòündåtion
22:15'
Caché
83 '.
Charleston, West Virginia
No
INFORMANT INFORMATION
Name: . Robert LBrown·¡:l .' . ". .... Relationship:
Mailing Address: 1450 JunipeE,HnLRq.ad, Pocatello,Idahöß3204 . .',
. :l
- ,,-··,::~';t,; "~~.:
DISPOSITION INFORMATION './\ /,,~. :1~~.:'."
Method ofDispositiÒì1: Cremation .": _ '. :.,Date 0.fDisposition:October'ŽiZ006
Place of Dispositión: Utab~FunerâL[)i~~.ctOrs Crem~tionCenter, South Jordan" Utah".
·,c. ,,.
FUNERAL HOME INFORMATION,-,."
Funeral Home: Allen-HallMoctuary .'
Address: . 34 Easrèenter Streê$, I.ogan,Utahß4321...... .
Funeral Director: Jason RAUen! 'i:," ...-
-, ~ ~.
(
MEDICAL CERTIFICATION '. ..-i ..... i..·.··.... . . . ..
Certifying Physician: .Agne.~'A §;~punar MD., }350North,500 East, Logan, Ut¡jI1,8~~41
CAUSE OF DEATH
Pneumonia
COPD
Malnutrition
Tobaccð· Use: Non-USèr .,-·F
Medical Examiner Contacted:::ioJO "Autôpsy pérformed:'No
;~' :,' :.;.
/
DÅTE ISSUED: October 6, 2006
AMENDMENT HISTORY
10/05/Z006 Conditions Contributing to Dea,{rom (blank) to Malnutrition
I . _.'
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! This is an exactreproduction of the document registered in the State Office of.VitaIStatistics/
Security features of this official document include: Intaglio Border, V &.R Images ¡ntop cycloids,
ultra violet fibers and hologram Image of a hawk over the w9rd valid. This document displays the
date, seâl and signature of the State Registrar and the County/DistrictHealth Officer.
Updated -Utah State Seal replaces hawk over valid for authènticity. ....... > .
~ê",-+ II~Ullmml~lm~1 . L~-
Barry E. Nangle, State Registrar * 0 6 1. 1. 6 6 1. 4 8 * Director/Health Officer
Office of Vital Statistics County/District l;iealth Department