HomeMy WebLinkAbout952015STATE OF UTAH
ss.
COUNTY OF SALT LAKE
STATEMENT OF TRUST AND
IDENTITY OF SUCCESSOR TRUSTEE
Pursuant to W.S. 34 -2 -123
O0:001-
RECEIVED 2/5/2010 at 3:28 PM
RECEIVING 952015
BOOK: 742 PAGE: 1
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Jean Ann Bills, of Murray, Salt Lake County, Utah, upon her oath deposes and says:
1. That she makes this affidavit as her recorded statement, duly verified, pursuant to
the provisions of W.S. 34 -2 -123 and in connection with the following described real property
located in Lincoln County, Wyoming:
Part of lots 2, 3, and 4 of block 26 to the town of Afton, Lincoln County,
Wyoming, described as follows:
Beginning at a point 13 rods West of the Southeast corner of lot 3 and running
thence North 10 rods; thence East 3 rods; thence North 21 rods; thence East 10
rods to a point 9 rods South of the Northeast corner of said lot 2; thence South
11 rods, 4 feet to the Northwest corner of said lot 4; thence East 10 rods (parallel
to the South boundary of Block 26) to a point that is 10 rods West of the East
boundary of Block 26; thence South 9 rods, 12 1/2 feet, more or less (parallel to
East boundary of Block 26), to a point that is 10 rods North of the South
boundary of Block 26; thence West 4 rods, more or less, (parallel to the South
boundary of Block 26); thence South 10 rods on a line parallel to the West
boundary of said lot 4, to a point on the South boundary of Block 26; thence
West 19 rods, along the South boundary of Block 26, to the point of beginning.
Less and Except property found in warranty deed recorded December 11, 2003
in book 543 at page 613, in the office of the clerk, Lincoln County, Wyoming.
Less and Except property found in warranty deed recorded January 1, 2007 in
book 645 at page 613, in the office of the clerk, Lincoln County, Wyoming.
Together with a perpetual right -of -way easement for ingress and egress as
described on warranty deed recorded December 31, 1979, in book 162 at page
580, in the office of the clerk, Lincoln County, Wyoming.
1
e06002
2. That the names of the grantees in that Quitclaim Deed dated September 25, 2000,
and recorded in the office of the Lincoln County Clerk on September 25, 2000, in Book 452PR,
page 649, Recording No. 868551, conveying the above described real property is hereby stated to
be as follows: Lucille Yvonne Shortt Trust, Lucille Yvonne Shortt and Alfred Bergen Shortt as
Trustees.
3. That she is a beneficiary of the trust referred to and hereby states that the correct
date of the trust is June 3, 1986.
84107.
4. That her name and address is Jean Ann Bills, 610 Holly Haven Circle, Murray, UT
5. That she is the daughter of Lucille Yvonne Shortt and Alfred Bergen Shortt, and a
beneficiary of the trust referred to, that Lucille Yvonne Shortt became deceased on January 7,
2003, that Alfred Bergen Shortt became deceased on October 2, 2009, that upon the death of
Alfred Bergen Shortt, Kelvin David Shortt and she became the Successor Co- Trustees under the
Lucille Yvonne Shortt Trust dated June 3, 1986.
6. That as of October 2, 2009, the date of death of Alfred Bergen Shortt, Jean Ann Bills
and Kelvin David Shortt became the Successor Co- Trustees under the Lucille Yvonne Shortt Trust
dated June 3, 1986, including its ownership of the real property described above, and that they are
currently lawfully serving in that capacity.
7. That she hereby verifies that the information contained in this Statement of Trust
and Identity of Successor Trustee is true and correct according to her information and belief.
DATED as of the 3 711 day of
`C✓1� Y`z-L i
2
2010.
Jean Ann Bills
2010.
Subscribed and sworn to by Jean Ann Bills before me this 34 day of
Witness my hand and official seal.
My commission expires: 2 U 1 Z
3
NOTARY PUBLIC
°0:003
CERTIFICATIO ITAL RECORDS
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STATE OF UTAH DEPARTMENT OF HEALTH 2G03 0 0 0 5 8 2
X 1 7 2003 �__o►� CERTIFICATE` OF DEATH
Rulsf LOCAL FILE NUMBER STATE FILE NUMBER
li e. 1. NAME OF DECEDENT FIRST MIDDLE UST 2. SEX 3+. DATE OF DEATH (Mo... O*Y• Y4 35.TIME OF DEATNR. h'4*.0
(r Lucille. Yvonne Shortt Female Jan 7, 2003
4. DATE OF BIRTH... o r, xd 5. AGE 1.616 J1HlW6y weer/ M meet P vlAA e, sae 6. BIRTHPLACE KAY y 6 SUN or Po,egACeunhy) ].SOCIAL SECURITY NUMBER
I 46161616
D. f0e,e6Ybee
8. Oct 14, 1922. Noep�e( 80'. 1 t Salt Lake City, UT CONFI
PLACE HOSPITAL: (416(11s oed.* for OTHER LOCATIONS: eb. NAME 01' HOSPRM R•
NURSING HOME OR OTHEFACILT'
R�
OF DEATH I (H eualdi a (68((14.OA'e ai'nMf 6ddI6sY O7bGIHOn)
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(clack 8n/ 4.'`11 t InPtl.nt G .*e /mm. a8, Reside,. y
ij *Iy 2. ERl0UIp0Mn1 a DOA I 7. Other s p e c i f y DIXIE REGIONAL, MEDICAL' CENTER
8c. CITY, TOWN OR LOCATION OF DEATH 80. COUNTY OF DEATH 8. SURVMNG SPOUSE(X »Tb,QM =olden nsma)
St.. George Washin ton Alfred 3 @rgen Shortt
DECEDENT 10 WAS DECEDENT 11. MARITAL STATUS 126. DECEDENTS USUAL OCCUPATION (G80 800 of melt done 126- 815001' BUSINESS 08 INDUSTRY
gy y Op I EVERIN ORC S. FORCES] 1. Neer Married 3 VKdotvetl a64gmo.t *n
w4n81ih. 0o NOT .460)
�I (`T ARMED
❑1. v.•® 2. No ®2 M *RMd 4 OloO eed Homemaker Own Home
l3a.RESIDENCE S ET AND NUMBER 136. CITY, TOWN; OR COMMUNITY 138. COUNTY 130. STATE
a. r 490,East Angie Ln Washignton Washington UT
130. BJSIDE NI
CITY 13T. ZIP CODE 14, WAS DECEDENT OF HISPANIC 0810847 1.166 2. No 18. RACE Black Week Am. 18, EDUCATION( 081' Y
1 LIMITS] Y... SMdtly 410416, (HIM 4 be Weed). wee *0.616140 ENmAtry a
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PARENTS
17 FATHER'S NAM (1111601, MMiddle, 1Last) 18 (M 4.
MAIDEN ME OF MOTHER (115. *'deb, Levy
Ar.thur.Loring Eldre Lucille Oswal
15:MI
NE, RELATIOSHIP M)OMAILINGADORESS OF INFORMANT
,INPORMAN7 Alfred Bergen Shortt :r Spou'ae 49A East Pirigip Ln, Washignton, UT 84780
20. METHOD OF DISPOSTON 216. DATE, OF DISP08n 2111; PLACE OF DIoPOemoe (nom of h
nreIly. 210 LOCATION Ca, e SIM*
CM8MI6(Y orclMrplew)
D 1. Entombment 'D 2. D*aDonee. 3. Other
DISPOSITION ®4. B,xtd 121'5 Galileo, D S. Removal
ZZ Jan 13, 2003 American Fork Cemete3y American Fork, (7
SIGNATURE OF E RVICE LICENSEE 3 1.1011136E M)M888 24. FUNERAL HOME (1468• d edr6r)
'y 9917138:, Metca3,f`Mortuary and 25. TE EDWAS 26 .g R 400683, 11
DaU3ed di"' ro� P°I 'Xs; ®2 No 288 west St. George Blvd
8 Yee.
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2 7 3 ,'1 CERTIFIER
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28•NAME AND ADIRESS F,PERSO(4.W110 CERTIFIED THE CAUSE OF DEATH, (ITEM 31)(T20*P44*8
O Judd LAROW$ 1.D 62;0 5',400 STE101,:St' George, UT, 84770
29. REGISTRARS SIGNATURE REGLETITLAR NOTIFIED OF,DFATH 30
b. DAT I E L N 1 PA ti Ht nn W.)
REGISTRAR" 31. PART I ENTER THE DI9 ,/E B UR1 5, OR COMPLICATIONS TH
AT C)WSiO THE DEATH: DO 815 0 1 0 :4.043
NOT ENTER THE MODE OF DYING. UCH AS 6081(008160 4nMe InMV10
OR RESPIRATORY ARREST, HOCK 4R HEART FAILURE. LIST ONLY 040E CAUSE O EACH LINE. Deem. M0
'l0. d.04h) 0 ET A CONSEQUENCE OF) t..)/-
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DEATH
ir48 AUnO 0 016 u,de,fytrl8 given NNONIJBER PRIO8 CDAtpIl:T,GIJ
CAUSE -OF 848. t. Pt806My 884111/60 to W6eeuw *d6edemas 0 s awe or 8051H,
2. vVe6 ti16661ryirq vuN d d661h
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fl 34. MANNER OF DEATH 386. OATS OF INJURWLO ry, D Yr.) 3811. 74 s OF 380W
INJURY WORk7 350. PAGE OF IWURY+V 0.8(0.6: (a8 m
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Forth l2, H Wv6d Inw.t80560 3,79 DESCRI48 &meanie wleen nsu0ldM
Rev. Y2K3u
CER
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,
ultraviolet fibers and hologram image of the Utah State Seal, over the words "State of Utah
This document displays the date, seal and signature of the State Registrar of Vital Statistics.
LINTgailliSSELA
UTAH DEPARTMENT OF HEALTH
Office of Vital Records Statistics
Salt Lake City, Utah
42C 4 61
DECEDENT INFORMATION
Date of Death: October 2, 2009
City of Death: Murray
Age: 88
Place of Birth: Salt Lake City, Utah
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
;_A
CERTIFICATION OF VITAL RECORD
Date Issued: October 14, 2009
Barry E.'Nangle, State Registrar
Office of Vital Statistics
CERTIFICATE OF DEATH
State File Number: 2009023682
Alfred Bergen Shortt
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Yes
Lucille Yvonne Eldredge (Deceased)Usual Occupation:
Utah Power Education:
Enoch, Utah Father's Name:
Matilde Olina Johnsen Facility Type:
St.•Mark's Hospital
INFORMANT INFORMATION
Name: Kelvin Relationsshi
Mailing Address: 4549 North Maple Lane, Enoch, .Utah 84 '721
16 :02,
Salt Lake
March 27,'1921
Male
Widowed
Transmission Specialist
Some College but No Degree
Charles Shortt
Hospital Inpatient
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: American Fork Cemetery, American Fork, Utah
Date. of Disposition: October 7, 2009
F HOME INFORMATION
Funeral Hone: Anderson Sons Mortuary
Address 49 East;100 North, Arl erican Fork, Utah 84003
Funeral Director: Alec S "Anderson
MEDICAL CERTIFICATION
Medical Professional: Sam!r N Wadhvania, St Mark's Hosptial„ 1200 East 3900 South, Salt Lake City, Utah 84126
CAUSE OF DEATH
Acute Respiratory Failure
Atrial Fibrillation
Pneumonia,
Tobacco Use: Unknown, if User
Medical Examiner Contacted: No Autopsy Performed: No Manner of Death Natural
.�Gry
"F ,,r.
t of OF T$ (lb
goo ip
This is anNexact 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 of Utah This
document displays the date, seal and of the State. Registrar and the County /District Health Officer.
1111 111 111111 o
c9 t K ?u cr�
Joseph K. Miner, MD, MSPH
Director /Health Officer
County /District Health, Department
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