HomeMy WebLinkAbout956913MARK TILLOTSON, of legal age, being first duly sworn, deposes and says:
1. That affiant is the surviving spouse of PAULA J. TILLOTSON.
2. That Affiant and PAULA J. TILLOTSON owned certain real property located in Lincoln
County, State of Wyoming, as joint tenants with full rights of survivorship and not as
tenants in common, and acquired title with:
A. Warranty Deed Entry f 1 '4 711 Book Page 2-1
which real property is more particularly described as follows:
Serial No.
AFFIDAVIT OF DEATH OF JOINT TENANT
Lot 401 in STAR VALLEY RANCH RV PARK PLAT ONE, as platted
and recorded in the official Records of Lincoln County, Wyoming, together
with all buildings, improvements and appurtenances thereon situated or
in anywise appertaining thereto.
Subject to any easements, reservations, easements, restrictions or rights -of-
ways of record, of sight or in use.
3. That PAULA J. TILLOTSON died on c ..Q2 +Cmi&f l a in IN L
County, Utah, and the said PAULA J. TILLOTSON was a resident of Weber County,
Utah, at the time of her death.
4. That on the death of the decedent, PAULA J. TILLOTSON, on 5 `Gn bar 2 00 all
of decedent's interest as a joint tenant in the said real property terminated.
5. That PAULA J. TILLOTSON is the same person as the PAULA JEAN BEECH TILLOTSON
named in. the attached State of Utah Certificate of Death
State File N er 2006011725.
DATED this day of 2010.
KAREN F MADDOX
NOTARY PUBLIC STATE of UTAH
COMMISSION NO. 580459
COMM. EXP. 10/15/2013
0007E16
RECEIVED 11/29/2010 at 10:55 AM
RECEIVING 956913
BOOK: 757 PAGE: 786
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF UTAH
)ss.
COUNTY OF WEBER
On this P day of 2010, personally appeared before me MARK
TILLOTSON, the signer of the foregoi Affidavit of Death of Joint Tenant, who duly
acknowledged to me that he executed the same.
My Commission Expires:
101 -1 3
KAREN F MADDOX
NOTARY PUBLIC STATE of UTAH
COMMISSION NO. 580459
COMM. EXP. 10/15/2013
o r
NOT A Y PUBLIC
Residing at:
mad_tox
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000787
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CERTIFICATIO +ITAL RECORD
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DECEDENT INFORMATIO
Date 'of.Death:
City of •Death:
Social Security Number:
Date of Birth]:
Sex:
Marital Status:
Usual Occupation:
Education:
Fathers Name:
Place of Death Type:
September 18, 2006
Ogden
March 12, 1947
Female
Married
Homemaker
Some College but No Degree'
James Hilton Beech
Home
STATE F UTAH
CERTIFICATE OF DEATH
State File Number:, 200601.1.725
Paula Jean Beech Tillotson
INFORMANT: INFORMATION
Name: Mark H Tillotson Relationship: ,Husband
Mailing Address: 1810 Shoshone, Ogden, Utah 84403
DISPOSITION INFORMATION
Method of Disposition: Burial Date ofDisposition: September 23, 2006
Place of Disposition: Lindquist's Memorial Gardens of the Wasatch, Ogden, Utah
FUNERAL HOME INFORMATION
Funeral Home: Lindquist Mortuary Ogden
Address: 3408 Washington Boulevard, Ogden, Utah 84401
Funeral Director: Craig iJ.Mcwl'Ilan
MEDICAL CERTIFICATION
Certifying Physician: Robert L Deters, 48 North
Time of Death:
County of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry /Business:
Residence:
Mother's Name:
Facility or Address:
Medical Drive, Office of Medical Examiner, Salt Lake City, Utah 84113
CAUSE OF DEATH
Strangulation By Ligature (Ha
Tobacco Use: l'Non- user
Medical Examiner Contacted: Yes Autopsy Performed:No Manner of Death: Suicide
INJURY INFORMATION
Date of injury:
Injury at Work:
Location of Injury:
How Injury Occurred:
Motor Vehicle Accident:
DATE ISSUED: September 21, 2006
Z
September 18, 2006 Time of injury: Unknown
No Place of Injury: Residence
1810 "Shosone, Ogden, Utah
Intentional, Self-Inflicted
Strangulation B'y Ligature (Hanging)
No
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 a hawk over the word valid. This document displays the
date, seal and signature of the State Registrar and the. County /District Health Officer.
Updated Utah State, Seal replaces hawk over valid for authenticity.
11111 01111111111
11
Barry E. Nangle, State Registrar 0 6 1 3 7 1 0 7 0*
Office of Vital Statistics
16:15
Weber
59
Ogden, Utah
No
Mark Henry Tillotson
Own Home
Ogden, Utah
Jean Redford Stoddard
1810 Shoshone
0007
ary House
Director /Health Officer
County /District Health Department
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