HomeMy WebLinkAbout960210STATE OF UTAH
County of Cache
RECEIVED 7/25/2011 at 12:16 PM
RECEIVING 960210
BOOK: 769 PAGE: 737
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT ESTABLISHING SUCCESSOR TRUSTEE
ss.
000737
L. BRENT HOGGAN, being first duly sworn on oath deposes and says:
1. He is a resident of North Logan, Cache County, Utah, over the age of twenty -one (21)
and is competent by personal knowledge to state and swear to the things hereinafter contained.
2. He is an attorney licensed to practice law in the State of Utah and was the attorney for
Gary K. Leishman during his lifetime.
3. Gary K. Leishman died on June 28, 2011. His death is evidenced by State of Utah
Certificate of Death State File number 2011007770 a copy of which is attached to this Affidavit.
Gary K. Leishman and Gary Keith Leishman named in said death certificate are one in the same
person.
4. On October 29, 1998, Gary K. Leishman and Carol J. Leishman, made and executed a
Declaration of Trust, creating the GARY K. AND CAROL J. LEISHMAN LIVING TRUST
"Trust which Trust was amended by a First Amendment thereto dated May 23, 2007 "First
Amendment: designated themselves as the trustees of the Trust during their lifetimes and
designated the survivor of them as Trustee on the death of the first of them to die.
5. Concurrent with the execution of the Trust Gary K. Leishman and his wife, Carol J.
Leishman made, signed and acknowledged a Warranty Deed conveying title to real property in
Lincoln County, Wyoming described as follows:
Star Valley Ranch RV Park Plat One (1) Forty -Five (45) as platted and recorded in the
Official Records of Lincoln County, Wyoming.
Said Warranty Deed was recorded on November 16, 1998, in Book 421 at Page 283 as Entry No.
854763 in the records of the Lincoln County, Wyoming Recorder "Property
6. By reason of the terms of the Trust and the death of Gary K. Leishman, Carol J.
Leishman has become the Trustee of the Trust and the owner of the Property as Trustee of the Trust.
7. This Affidavit is made for the purpose of establishing that Carol J. Leishman is the
owner the Property as Trustee of the Trust.
DATED this .2Z -d"ay of July, 2011.
STATE OF UTAH
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County of Cache
L131 /Im
J: \LDI- RESTATE \Leishmmn, Gary Carol\Aff. Est. S.T_WY.doc
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2
L. Brent Hoggan
On theZAlay of July, 2011 personally appeared before me L. BRENT HOGGAN, the
signer of the within instrument, who duly acknowledged to me that he executed the same.
NOTARY PUBLIC
AMANDA DAVIS
NOTARY PUBLIC:. STATE OF UTAH
Sly Comm. 11/05/2012
Commission 0,576526
00073s
CERTIFICATION OF VITAL RECORD
i' 1' t'•: fVYIiY "15':Y'!Y'•J'•ti'•ti'lY:ti "!'1'1'-4. +1••, F. V ••n.•n•.•7•n ANW.Ve W1 eAV•
Janice L. Houston, State Registrar
Office of Vital Statistics
Manner of Death: Natural.
Wife
Lloyd Berentzen
Director/Health Officer
County/District Health Department
DECEDENT INFORMATION
Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's. Name:
Facility or Address:
June 28, 2011
Ogden
75
Logan, Utah
Yes
Carol Louise Jessop
Construction Nucor Steel
Wellsville, Utah
Irene Anderson
McKay -Dee Hospital Center
W.sTI II MIL J IU N.
CERTIFICATE OF DEATH
State File Number:, 2011007770
Gary Keith Leishman
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
INFORMANT INFORMATION
Name: Carol Leishman Relationship:
Mailing Address: 130 South 300 East, Wellsville, Utah 84339
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Wellsville Cemetery, "Wellsville, Utah
Date of Disposition: July 2, 2011
FUNERAL HOME INFORMATION
Funeral Home: /Allen -Hall Mortuary
Address: 34 East Center Street, Logan, Utah 84321
Funeral Director: Jason R Allen
MEDICAL CERTIFICATION
Medical Professional: Joel Pittman MD, 4403 Harrison Blvd, Suite 3815, Ogden (Weber), Utah 84403
CAUSE OF DEATH
Respiratory failure
Due to (or as a consequence of): Pulmonary hypertension
Due to (or as a consequence of): Interstitial lung disease
Due to (or as a consequence of): Scleroderma
Other significant conditions: Sarcoidosis
Tobacco Use: Unknown
Medical Examiner Contacted: No Autopsy Performed: No
Date Issued: July 6, 2011
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
uItr� violet 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 and the County/District Health Officer.
II 111111 1 ll 111 11 111 1 11
12:26
Weber
April 4, '1936
Male
Married
Heavy Equipment Operator Yard Supervisor
High School or GED
Keith Cooper Leishman
Hospital Inpatient
000739