HomeMy WebLinkAbout964464WHEN RECORDED MAIL TO:
MARK JOHNSON, Trustee
1960 Ridgeview Drive
Longmount, CO 80504
STATE OF UTAH
SS:
COUNTY OF WASHINGTON
AFFIDAVIT OF SUCCESSOR TRUSTEE
00794
AFFIANT, being first duly sworn, deposes and says:
1. That ROBERT C. JOHNSON and EMILY V. JOHNSON created the ROBERT
C. JOHNSON FAMILY TRUST, originally dated May 1, 2001, wherein ROBERT C.
JOHNSON was designated as the original Trustee.
2. That ROBERT C. JOHNSON died on the 10th day of April, 2012, and a
certified copy of the Death Certificate is attached hereto and by this reference incorporated
herein.
3. That MARK JOHNSON and DAVID JOHNSON are named in said Trust as the
Successor Co- Trustees of the Trust; and MARK JOHNSON hereby files this certificate and
accepts the Trusteeship of the ROBERT C. JOHNSON FAMILY TRUST, originally dated May
1, 2001 and that DAVID JOHNSON has declined to serve as a Successor Co- Trustee and a copy
of his declination to serve is attached.
4. That there is real property owned by the Trust located in Lincoln County, State
of Wyoming, described as follows:
Lot Sixty -Eight (68) in STAR VALLEY RANCH PLAT THIRTEEN (13) as
platted and recorded in the Official Records of Li coln County, Wyoming.
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MARS OH Ile
DATED this day of April, 2012.
STATE OF UTAH
SS.
COUNTY OF WASHINGTON
On this 1 day of April, 2012, personally appeared before me, a Notary Public,
MARK JOHNSON, who acknowledged to me that he executed the above instrument, as the
Successor Trustee of the ROBERT C. JOHNSON FAMILY TRUST, originally dated May 1,
2001.
NOTARY PUBLIC
RECEIVED 5/9/2012 at 10 :32 AM
RECEIVING 96
BOOK: 785 PAGE: 794
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
s J
;1
VERTIFICATII
VITAL RECORD
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DECEDENT INFORMATION
Date of Death: April 10, 2012
City of Death: St. George
Age: 86
Place-of Birth: Clarksburg, West Virginia
Armed Services:: Yes
Spouse$ Name_:-
Industry/Business: Mining
Residence: St George, Utah
Mother's Name: Margaret Lyons
Facility-or Address: Platinum Care Assisted Living
INFORMANT INFORMATION
CERTIFICATE OF DEATH
State,File Number: 2012094563
Robert C Johnson
Time of Death:
County of Death:
Date OtBirth:,
Sex:
Marital
Usual;OccuRation:
Edudation:
Father's Name:
Facility Type:
Name: Mark Johnson Relationship: Son
Mailing Address: 1960 Ridgeview Drive, Longmont, Colorado 80504
DISPOSITION INFORMATION
Method of Disposition: Cremation
Place of Disposition: Metcalf Mortuary, St George, Utah
Date of Disposition: April 13, 2012
FUNERAL •HOME INfORMATION
Funeral Home: Metcalf Mortuary
Address: 288 West St George Blvd, St George, Utah 84770
Funeral Director: Dustin W Mortenson
MEDICAL CERTIFICATION
MedicaProfessiorIal: Bruce Taylor MD, 577 South River Road, St George Utah-84790
CAUSE DEATH
Congestive Heart Failure
Due to (or as a consequence of): Chronic Obstructive Pulmonary Disease
Tobacco Use: .Unknown
Medical Examiner Contacted: Yes Autopsy Performed: No Manner ofDeathf
Date Issued: April 12, 2012
This is an exact reproduction of the registerectinthe State Office of Vital Statistics.
Sedurity features of this official document include Intaglio Border Y& R images in top cycloids,
ultra violet fibers and hologram image of Utah State Seal ,rover thewords "State of Utah This
document isplays the date, seal and signature of-the Statekegistrar and the County/District Health Officer.
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-Janice.L. Houstoft, State Registrar
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Washington
February 5,1926
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Widowed
HR Manager
Bachelor's Degree
Forrest Johnson
Nursing Home/Assisted Living
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David W. Blodgett
Director/Health Officer
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DECLINATION TO SERVE AS TRUSTEE
The undersigned, being duly sworn, depose and say:
1. That ROBERT C. JOHNSON and EMILY V JOHNSON created the ROBERT
C. JOHNSON FAMILY TRUST, originally dated May 1, 2001, wherein ROBERT C.
JOHNSON was acting as the current Trustee and MARK JOHNSON and DAVID JOHNSON
were named as the Successor Co- Trustees.
2. That ROBERT C. JOHNSON died on April 10, 2012.
3. That DAVID JOHNSON desires not to serve as one of the Successor Co- Trustees
of this Trust and hereby declines to serve as one of the Successor Co- Trustees of the ROBERT
C. JOHNSON FAMILY TRUST, originally dated May 1, 2001, effective as of the 12th day of
April, 2012.
DATED this 12th day of April, 2012.
D VID JOHN N
STATE OF UTAH
ss.
COUNTY OF WASHINGTON
On April 12, 2012, before me, the undersigned, a Notary Public in and for such County
and State, personally appeared DAVID JOHNSON, known to me to be one of the Successor Co-
Trustees whose name is subscribed to the within instrument and who acknowledged to me that
he executed the same.
IN WITNESS WHEREOF, I have hereunto set my hand and seat the day and year in this
certificate first above written.
NOTARY PUBLIC
SARAH FAIRCHILD
583207
COMMISSION EXPIRES
JUNE 28, 2014
STATE OF UTAH
4if/. 4
NOTARY PUBLIC
NOTARY PUBLIC
SARAH FAIRCHILD
583207
COMMISSION EXPIRES
JUNE 28, 2014
STATE OF UTAH
00796