HomeMy WebLinkAbout960723SCOTT CLARK RA8MMEN
COMMISSION 11607
COMM. EXP. 10.282014
My Commission Expires:
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Affidavit of Successor Trustees
We, Phil J. Smith and Judy Bell, being of lawful age and duly sworn according to law, upon
our oath, depose and state:
That under the date May 26, 1998, Jesse A. Smith and Mary Jo Smith, by deed of that
date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on May 28,
1998, in Book 412 of Photostatic Records on Page 248, conveyed to Jesse A. Smith and Mary Jo
Smith AKA Jo S. Smith, Trustees of the Jesse A. Smith and Mary Jo Smith Revocable Trust
dated April 9, 1998, the following described property situate in Lincoln County, Wyoming, to -wit:
Lot 105 of Star Valley Ranch Plat 18, Lincoln County, Wyoming as described on the official plat
thereof
That by reason of said conveyance aforesaid, Jesse A. Smith and Mary Jo Smith AKA Jo
S. Smith, Trustees of the Jesse A. Smith and Mary Jo Smith Revocable Trust dated April 9, 1998,
became the owners of the above described land, and title thereto vested continuously in said
trustees from the date of conveyance described in said deed to the date of death of Mary Jo
Smith on the 28th day of April, 2011, and to the date of death of Jesse A. Smith, also known as
Jesse Albert Smith on the 12th day of July, 2011. That by reason of and upon the deaths of
Jesse A. Smith and Mary Jo Smith and pursuant to Section 1 A., Article 1, subparagraph F of the
Trust, as amended November 15, 2010, title to the above described real property vested in Phil J.
Smith and Judy Bell, as the successor trustees.
Affiants aver and certify that Mary Jo Smith and Jesse A. Smith, also known as Jesse
Albert Smith, are the identical parties named as trustees in the aforementioned deed, whose
deaths terminated their interest, title and estate in said real property; and Affiants attach hereto
and make a part of this affidavit, copies of the Official Certificates of Death of said decedents,
duly certified by the public authority in which said death certificates are a matter of record.
Dated this day of fRJt?Z S 2011.
t lx.
State of U.
County of
Subscribed d wom to be re me, notary public in and for said County and State, by
Phil J. Smith, this day of „r 2011.
WITNESS my hand and official seal.
)ss.
(See page 2 for additional signature and notary acknowledgement)
RECEIVED 8/26/2011 at 1:17 PM
RECEIVING 960723
BOOK: 771 PAGE: 690
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
000690
1
State of A
County of we
)ss.
SCOTT CLARK RASMUSSEN
NOZIRTFU1UC- STATEOFUTAN
COMMISSION #602557
COMM. EXP. 10.2$ 2014
My Commission Expires: t0 79( �v 7�
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Subscrib d swom to fore otary public in and for said County and State, by
Judy Bell, this day of 2011.
WITNESS my hand and official seal.
000691
2
CERTIFICATI
VITAL RECORD
lt!•_1••.. r �Y•t••t.1. •Y•J !YY' "t ir•il V.r1i:..V•Y 51.1 YV"Yt'•t'�i ti "''!''YYY•1 •.•lY Vrt.... .l li4 r -1 Y'Y11111.1rl1 .1.11'!•41• •i... ;YttY 44.•.4. Y'
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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:
Date Issued: May 5, 2011
alp �I�y of
ryaV
April 28, 2011
Roy
74
Ogden, Utah
No
Jesse'A Smith
Hill Air Force Base
Roy, Utah
Marie Hegstead
3775 West 5900 South
INFORMANT INFORMATION
Name: Judy S Bell Relationship: Daughter
Mailing Address: 3775 West 5900 South, Roy, Utah 84067
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: Lindquist's Crematory, Ogden, Utah
Date of Disposition: May 3, 2011
FUNERAL HOME INFORMATION
Funeral Home: Lindquist Mortuary Roy
Address: 3333 W st 5600 South, Roy, Utah 84067
Funeral Director: Rusty D Conway
MEDICAL CERTIFICATION
Medical Professional:, Nelson Astle MD, West Side Medical, 1477 North 2000 West, Clinton, Utah 84015
CAUSE OF DEATH
Chronic obstructive pulmonary disease [Onset: 5 Years]
Tobacco Use: Unknown if User
Medical Examiner Contacted: Yes Autopsy Performed: No Manner of Death: Natural
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 of Utah This
document displays the date, seal and signature of the State Registrar and the /District Health Officer.
WILIKEILIP
CERTIFICATE OF DEATH
State File Number: 2011005207
i Mary Jo Smith
Janice L. Houston, State Registrar
Office of Vital Statistics
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
MUI911J
\Q
000692
23:15
Weber
March 23, 1937
Female
Married
Civil Service
Some College but No Degree
Franklin Rawson
Home
ary House
Director /Health Officer
County /District Health Department
it
PN
CERTIFICATION OF VITAL RECORD
Y.
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:
Date Issued: July 19, 2011
YYi1Y'iYY:YYY: Y'i YY "Yt''I'i
July 12, 2011
Roy
77
Ogden, Utah
Yes
INFORMANT INFORMATION
Name: Judy Bell
Hill Air Foce Base Military
Roy; Utah
Phyllis Francis Hooker
3775 West 5900 South
Mailing Address: 3775 West 5900 South, Roy, Utah 84067
DISPOSITION .INFORMATION
Method of. Disposition: Cremation
Place of Disposition: Lindquist's Crematory, Ogden, Utah''
Date of Disposition: July 18, 2011
FUNERAL HOME INFORMATION
Funeral Home: Lindquist Mortuary Roy
Address: 3333 West 5600 South, Roy, Utah 84067
Funeral Director: Scott J Case
MEDICAL CERTIFICATION
Medical Professional: Brannick Riggs MD, 5991 South 3500 West #400, Roy (Weber), Utah 84067
CAUSE OF DEATH
Congestive heart failure
Due to (or as a consequence of): Coronary artery disease
Due to (or as a consequence of): Diabetes, mellitus
Due to (or as a consequence of): Prostate cancer
Tobacco Use Did not Contribute
Medical Examiner Contacted: Yes Autopsy Performed: No Manner of Death: Natural
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 of Utah This
document displays the date, seal and signature of the State Registrar and the County/District Health Officer.
ill
CERTIFICATE OF DEATH
State File Number: 2011008407
Jesse Albert Smith
11
11
11
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:'
Usual Occupation:
Education:
Father's Name:
Facility Type:
Relationship:
111111111
*063039788.*
000693
11:55
Weber
June 17, 1934
Male
Widowed
Scheduler
Some College but No Degree
Jesse Walter Smith
Home
Daughter
ary House
Director /Health Officer
County /District Health Department
r o
De 1 1 A
11
PIM
o
VA ALA
Janice L. Houston, State Registrar
Office of Vital Statistics
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