HomeMy WebLinkAbout964517AFTER RECORDING PLEASE RETURN TO:
DAINES, THOMAS SMITH, LLP
1 35 N MAIN, SUITE 200
LOGAN, UTAH 84321
MAIL TAX NOTICES TO:
CRAIG D. ANDERSON
350 EAST 200 SOUTH
HYRUM, UTAH 84319
DATED this day of May, 2012.
STATE OF UTAH
County of Cache
ss.
AFFIDAVIT
Whereas I, Craig D. Anderson, have known Theodore Oscar Anderson aka Theodore O. Anderson
for a great number of years. I know that Theodore Oscar Anderson aka Theodore O. Anderson deceased,
shown in the attached death certificate, is one and the same person as Theodore O. 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 of Wyoming as
follows:
Legal Description attached as Exhibit "A"
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On the t day of May, 2012, personally appeared before me CRAIG D. ANDERSON, the signer
of the within instrument, who duly acknowledged to me that he executed the same.
RECEIVED 5/14/2012 at 10:59 AM
RECEIVING 964517
BOOK: 786 PAGE: 133
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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CERTIFICATE OF
DATE FILED: NOVEMBER 18, 1905
DECEDENT: THEODORE OSCAR ANDERSON
DATE OF DEATH: NOV. 06, 1985
DATE OF BIRTH: JAN. 04, 1 908
AGE: 77 YEARS SEX! YALE
MARITAL STATUS: SINGLE
SOCIAL SECURITY NUMBER
FATHER: PARLEY T. ANDERSON
MOTHER: LAURA HUNTER
MORTUARY: MATTHEWS MORTUARY,
CERTIFIER: PAUL H. DAINES JR. MD
1. CAUSE OF DENTE', UNDERLYING CAUSE LAST
ACUTE MYOCARDIAL INFARCTION
ALZHEIMER S DISEASE
BEE BIGGS, R.N. State Registrar
00 NOT ACCEPT UNLESS ON SECURITY PAPER. WITH EMBOSSED SEAL OF IDAHO
DEPT. OF HEALTH WELFARE CLEARLY AFFIXED.
Seelion 322.213, Idaho Cush_
HWH0139
D EATH
1150 W STATE ST.
.110ISIE. IDAHO 83720
STATE FILE NUMBER: 85- 0575`
PLACE OF DEATH: MONTPELIER, IDAHO
PLACE OF BIRTH: UTAH
CITIZENSHIP: UNITED STATES
SURVIVING SPOUSE:
RESIDENCE: BORDER, WYOMING
AUTOPSY: NO
DATE ISSUED: NOVEMBER 19, 1985
This is to certify that this is a true anal ce;rcct reproduction or abstract of the official record
filed with the Idaho Department of Health. (Welfare, Boise, Idaho.
INC. MONTPELIER, ID
VETERAN? NO
OTHER CONDITIONS CONTRIBUTING TO DEATH BUT UNRELATED TO ABOVE CAUSES:
INTERVAL
IMMEDIATE
2 YEARS