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ickman
Id1It1eCo
SINCE 1904
RECEIVED 10/4/2011 at 1:20 PM
RECEIVING 961254
BOOK: 773 PAGE: 702
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT
I, LAZELL W. ALLEN, being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America over the age of 21 years, and a
resident of Utah.
000702
That I was well and personally acquainted with DENZEL WALTON WOOD and
LARUE MERRITT WOOD one of the Trustees of the WOOD FAMILY TRUST dated the 12
day of May, 1995 in that certain Warranty Deed dated May 12, 1995 and recorded June 20, 1995
in Book 369PR, at Page 763, as Filing No. 803882, in the office of the Recorder of Kemmerer
County, Utah.
That I know of my own knowledge that DENZEL W. WOOD in the said deed and
DENZEL WALTON WOOD mentioned in the attached Certified Copy of Certificate of Death
was one and the same person.
That I know of my own knowledge that LARUE M. WOOD in the said deed and LARUE
MERRITT WOOD mentioned in the attached Certified Copy of Certificate of Death was one and
the same person.
This affidavit is intended to terminate the Trusteeship of said DENZEL W. WOOD and
LARUE M. WOOD in said Trust in the following described property:
Commencing at the Northwest corner of the East half of the Northeast quarter of Section 34,
Township 32 North, Range 119 West of the 6 Principal Meridian, in Wyoming, and running
thence East 53 -1/3 rods; thence South 160 rods; thence West 53 -1/3 rods; thence North 160 rods
to the point of beginning, containing 53 -1/3 acres of land.
Tax Roll No. 32193410028900
Dated this 2 day of September 2011 A.D.
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DATE ISSUED
This is an exact reproduction of the doc 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.
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Barry E. Naugle, State Registrar
Office of Vital Statistics
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Lloyd Berentzen
Director/Health Officer
County /District Health Department
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Lloyd Berentzen
Director /Health Officer
County /District Health Department
DECEDENT INFORMATION
Date of Death: September 25, 2008
City of Death: Logan
Age: 83
Place of Birth: Afton, Wyoming
Armed Services: No
Spouse's Name:
Industry/Business: Own home
Residence: Logan, Utah
Mother's Name: Ida Taysom
Facility or Address: Terrace Grove
INFORMANT INFORMATION
Name: Daniel T Wood Relationship:.
Mailing Address: 1296 East 1770 North, North Logan, Utah 84341.
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Auburn Cemetery, Auburn, Wyoming
FUNERAL HOME INFORMATION
Funeral Home: Allen Mortuary
Address: 420 East 1800 North, Logan, Utah 84341
Funeral Director: John P Stevenson
MEDICAL CERTIFICATION
Certifying Physician: Michael J Stones MD, Intermountain Budge Clinic, 1350 North 500 East, Logan, Utah 84341
CAUSE OF DEATH
Right sided heart failure [Onset: 2 Years]
Tobacco Use: Non user
Medical Examiner.Contacted: No Autopsy Performed: No Manner of Death: Natural
Date Issued: September 30, 2008
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C ERTIFICATI a ITAL RECORD a 'd
CERTIFICATE OF DEATH
State File Nymber: 2008010975
LaRue Merritt Wood
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.
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Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
Son
15:15
Cache
August 29, 1925
Female
Widowed
Homemaker
High School or GED
Samuel Therin Merritt
Nursing Home /Assisted
Date of Disposition: September 30, 2008
1111 fl
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