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AFFIDAVIT OF SURVIVORSHIP
STATE OF WYOMING )
) ss.
COUNTY OF LINCOLN )
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I, JEAN MARIE ANNALA, being of legal age and first duly sworn, deposes and says as
follows:
1. That I am the surviving spouse of Carl A. Annala who died testate on June 7, 2008 in the
City of Kemmerer, County of Lincoln, State of Wyoming.
2. At the time of his death Carl A. Annala was a resident of Lincoln County, Wyoming.
3. Carl A. Annala had a will that distributed all of his property to Carl A. Annala and Jean
Marie Annala, Trustees, or their successors in Trust under the Carl A. Annala Living Trust
dated September 4, 1996.
4. I am a successor trustee of the Carl A. Annala Living Trust, dated September 4, 1996 and
have completed an affidavit accepting my appointment.
5. The Carl A. Annala Living Trust, dated September 4, 1996 is the sole heir and distributee
of Carl A. Annala and there are no other heirs or distributees having a right to succeed to the
property of Carl A. Annala.
6. That thirty (30) days have lapsed since the death of Carl A. Annala.
7. That no application for appointment of a personal representative is pending or has been
granted in any jurisdiction.
8. The Carl A. Annala Living Trust, dated September 4, 1996 is entitled to the payment or
delivery ofthe property of Carl A. Annala and there are no other distributees ofthe Decedent
having a right to succeed to the property under probate proceedings.
9. That the personal property owned by Carl A. Annala is as follows:
a. 1970 Open Road Travel Trailer; VIN #1267
b. 1978 Buick Sedan; VIN #4U69K8H600648
c. 1986 Suzuki 4-Wheel ATV; VIN #JSAAJ4SA 8G2108219
10. That if any other personal property is located that is not identified above, the Carl A. A1mala
Living Trust, dated September 4, 1996 is entitled to that property.
Qè.
Dated this 2- - day of September, 2008.
RECEIVED 3/20/2009 at 3:17 PM
RECEIVING # 946045
BOOK: 718 PAGE: 310
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
~ - ()
JE~~~~~~~,~successor Tru;e -
ofthe Carl A. Annala Living Trust, dated 9/4/1996
STATE OF WYOMING
)
) ss.
)
C:OÚ31.1.
COUNTY OF LINCOLN
Subscribed and sworn to before me by Jean Marie Annala, Successor Trustee of the Carl
A. Annala Living Trust, dated September 4, 1996, this ,.) rtd day of September, 2008.
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NOTARY PUBLIC
My Commission Expires:
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INFORMANT INFORMATION
Name: Jean Marie Annala Relationship:
Mailing Address: P.O. Box 44~piam()ndville,Wyol11ing 831.16
DISPOSITION INFORMATION,': ". ...,
Method of Disposition: Cremation '.<> Date of Disposition: June 10,"2008
Place of Disposition: Uta~F.uneralpi~~c.tors Cremation Center, South Jordan, Utah'>
DECEDENT INFORMATION
Date of Death:
City of Death:
Age: /
Place of Birth~
Armed Services:
Spoûse's Name:
I ndu~ry/Business:
Residence:
Mother's Name:
Facility or Address:
¡CERTIFICATE OF DEATH
State File Number: 2od8006787
I'
Carl Alvin Annala
(:00312
June 7, 2008
Salt Lake City
69 I
Diamondville, Wyoming
Yes
Jean Marie Little
Power Plant
Diamondville, Wyoming
Terra Marie Niirenen
University of Utah Hospital
Time of Death:
'County ofÓeath:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
01:08
Salt Lake
NovEfmber 19,1938
Male
Married..
Electrician
Some College but No Degree /
J~cob Annala
Hospital Inpatient
''-..
, Spouse
I
/
FUNERAL HOME INFORMATION \
Funeral Home: Crandall Fun~ral Home
Address: Þ·O BoxG, 105 EastCehter Street, Kamas,Utah 84036
,Funeral Director: William, W Ball " , . '\
M~~~~i~~~~:li~:~: TIONco~'rtri~y L Scaif~ M[):5d;North~~diCéll DriVe;$altLak~:City, Utah 841';2
CAUSE OF DEATH
Metastatic carcinoma
Tobacco USE(:Unknown:i;c;,
Medical Examiner Contacted: No AlÌtopsyPetformed::Yes
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June 16, 2008
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Auto~sy Avail~ble:.No Manner 6rDeath:"Natural
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This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V & R images in top¡cycloids,
ultra violet fibers and hologram Image of the Utah'State Seal, over the words "State ofOtah". This
document displays the,date, seal and signature of the State Registrar and the County/District Health Officer.
~ê~·.
Barry E. Nangle, State Registrar
Office of Vital Statistics
II~IIIIIIII~IIIIIIIIII'IIIIII ~IIIIIIIIII~ IIIIII~
~.,~~
Gar~dWards
Dlrector/Health Officer
County/District Health Department
*06l597083*