HomeMy WebLinkAbout962842AFTER RECORDING PLEASE RETURN TO
DAINES, THOMAS SMITH, LLP
135 N MAIN, SUITE 200
LOGAN, UTAH 84321
MAIL TAX NOTICES TO:
CRAIG D. ANDERSON
350 EAST 200 SOUTH
HYRUM, UTAH 84319
Whereas I, Craig D. Anderson, have known Claudia Mae Anderson aka Claudia M. Anderson for a
great number of years. I know that Claudia Mae Anderson aka Claudia M. Anderson deceased, shown in
the attached death certificate, is one and the same person as Claudia M. Anderson shown in the following
Warranty Deed:
1. A Warranty Deed recorded on September 26, 1984, as Entry No. 623806, in
Book 218PR, Page 871, in the Lincoln County Recorder's Office, and
describing property situated in Lincoln County, State ofWyoming as follows:
DATED this f j day of January, 2012.
STATE OF UTAH
ss.
County of Cache
t
the E day of January, 2012, personally appeared before me CRAIG D. ANDERSON, the
signer of the within instrument, who duly acknowledged to me that he executed the same.
NOTARY vtiar
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;TATS OF UTAH:
RECEIVED 1/20/2012 at 11:16 AM
RECEIVING 962842
BOOK: 779 PAGE: 597
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Legal Description attached as Exhibit "A"
AFFIDAVIT
A
Notary Public
CRAIG ANDERSON
00597
CERTIFICATI
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: October 26, 2011
`iv�r vow #ri
Janice L. Houston, State Registrar
g j r Office of Vital Statistics
CERTIFICATE OF DEATH
State File Number: 2011012667
Claudia Mae Anderson
October 22, 2011
Logan
75
Soda Springs, Idaho
No
Home
Flyrum, Utah
Adelene McClain
Logan Nursing Rehab Center
INFORMANT INFORMATION
Name: Carrie Goodsell Relationship:
Mailing Address: 178 South 6800 West, Petersboro, Utah 84325
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Hyrum City Cemetery, Hyrum, Utah
Date of Disposition: October 29, 2011
FUNERAL HOME INFORMATION
Funeral Home: Nelson Funeral Home
Address: 162 East 400 North, Logan, Utah 84321
Funeral Director: Michael Chatterton
MEDICAL CERTIFICATION
Medical Professional: Jeffrey S Strong MD, IHC Budge Clinic, 1350 North 500 East, Logan, Utah 84341
CAUSE OF DEATH
Breast Cancer
Tobacco Use: Non -user
Medical Examiner Contacted: No 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 i clude: Intaglio Border, V R images in topcycloids,
��`�a����a ultra violet fibers and hologram image of the Utah State Seal, over the words "State of Utah This
i of 11,„ 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:
1 1
*063116967*
10:50
Cache
May 6, 1936
Female
Widowed
Homemaker
High School or GED
Claude Netherley
Nursing Home /Assisted Living
Daughter
Lloyd Berentzen
Director/Health Officer
County /District Health Department
00598
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