HomeMy WebLinkAbout964712Mail tax statements to:
Wallace R. Humphreys, Trustee
The Humphreys Family Trust
2156 West 1740 North
St. George, Utah 84770
When recorded, return to:
Rowe Walton PC
Robyn Rowe Walton
Attorney at Law
915 South Main
Bountiful, Utah 84010
SURVIVOR AFFIDAVIT,
CERTIFICATE OF IDENTITY CERTIFICATE OF INCUMBENCY
WALLACE R. HUMPHREYS, hereinafter referred to as "Affiant having
been duly sworn, on oath, deposes and says:
1. That Affiant is over the age of eighteen (18) is a resident of
Washington County, State of Utah, is competent to testify to the
matters herein, and does so from personal knowledge.
2. That Affiant is the Successor Trustee to THE HUMPHREYS FAMILY TRUST
dated the 8th day of March, 1994, and that up until the date of her
death, SARAH H. HUMPHREYS was a Co- Trustee of said trust agreement.
3. That SARAH H. HUMPHREYS aka SARAH HELEN JAMES HUMPHRIES aka SARAH
HELEN JAMES HUMPHREYS died on the 27 day of November, 2003; a
certified copy of the death certificate acknowledging her death is
attached hereto and by reference made a part hereof.
4. That LEISURE VALLEY, INC. conveyed any and all interest in the
below described property to WALLACE R. AND SARAH H. HUMPHREY FAMILY
TRUST dtd 3/08/94, WALLACE R. HUMPHREYS and SARAH H. HUMPHREYS,
Trustees, by a certain Warranty Deed recorded the 5th day of May,
1997, as No. 0837033, Book 396PR, Page 839, covering the following
property situated in Lincoln County, State of Wyoming:
STAR VALLEY RANCH RV PARK PLAT 1 LOT 132 AS
PLATTED AND RECORDED IN THE OFFICIAL RECORDS
OF LINCOLN COUNTY, WYOMING. RESERVING
THEREFROM ALL RIGHTS, TITLE, AND INTEREST IN
AND TO ANY AND ALL MINERALS RIGHTS
APPERTAINING THERETO. SUBJECT TO ALL
DECLARATIONS OF COVENANTS, CONDITIONS AND
RESTRICTIONS OF RECORD.
1
0608
RECEIVED 5/24/2012 at 10:21 AM
RECEIVING 964712
BOOK:786 PAGE:608
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
5. That SARAH HELEN JAMES HUMPHREES aka SARAH HELEN JAMES HUMPHREYS
named as the deceased in the certified copy of the death certificate
hereto attached, is the same person as SARAH H. HUMPHREYS named in
said Warranty Deed above referred to.
6. That WALLACE R. AND SARAH H. HUMPHREYS FAMILY TRUST dtd 3/08/94, as
referenced in the Warranty Deed (above #4), is one and the same as
THE HUMPHREYS FAMILY TRUST dated the 8th day of March, 1994.
7. That by reason of the death of SARAH H. HUMPHREYS, and pursuant to
Article VIII., of said Trust Agreement, the Affiant, WALLACE R.
HUMPHREYS, has become the Successor Trustee of THE HUMPHREYS FAMILY
TRUST, dated the 8th day of March, 1994.
8. That the Affiant does hereby accept the incumbency to serve in said
capacity as Successor Trustee of said Trust; that by reason of the
death of SARAH H. HUMPHREYS, and the terms of said Trust Agreement,
Affiant as Successor Trustee and with the power and authority vested
in him by reason of said Trust, does accept the above described
property as Successor Trustee of said Trust Agreement and the
position of Successor Trustee and agrees to perform all duties and
functions according to said trust instrument.
9 The Undersigned, as Successor Trustee of THE HUMPHREYS FAMILY TRUST
dated the 8th day of March, 1994, does hereby remove the name of
SARAH H. HUMPHREYS, Trustee of THE HUMPHREYS FAMILY TRUST dtd
03/08/94, and said property shall be titled from this date forward
as: WALLACE R. HUMPHREYS, Trustee or Successor Trustees of THE
HUMPHREYS FAMILY TRUST, dated the' 8th day of March, 1994, of St.
George, County of Washington, State of Utah.
DATED this day of May, 2012.
I,L) 62.UJL J j tr cv E
WALLACE R. HUMPHRE Trustee
THE HUMPHREYS FAMILY TRUST
dated the 8th day of March, 1994
STATE OF UTAH
P/ :ss.
COUNTY S
On this day of May, 2012, personally appeared before me
WALLACE R. HUMPHREYS, Successor Trustee of THE HUMPHREYS FAMILY TRUST
dated the 8th day of March, 1994, who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to on
this instrument, and acknowledged that she ex- tog the same.
T
NOTARY PUBLIC
Brandon Howard Eves
583612
My Commission Expires
07/21/2014
STATE OF UTAH
2
A, 4 P:Or,
'WA •Y •i:LIC
Residing at Davis County
00609
EPARTMENT OF HEALT
WARNING: IT IS ILLEGAL TO DUPLICATE THIS COPY FOR OFFICIAL PURPOSES.
ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATION 7
THIS AFFIDAVIT FOAM,CAj QNLY BE TO MAKE CORRECTIONS ON
STATEMENT OF
AMENDINENtS;
PrtOOF6 USED TO 1G.
AM EN° tEboteb
OATH OF FIRST
+srrNES
S
OATH OFFSECOND
WITNESS
FOR USE OP STATE
REHISIRAR
00610
STATE OF (JY?!v} 1 p1` PAR AFFIDAVi LA1jE=N7- OF 4 ETQ i I ALTH DF E A OF R ECO VITAL RRD 5T
ECORDS AND ATISSnC$�
'herebycamify uftd1t�eA
r attyolpadury, "that 1 have personal knowledge of the
above thaithe information give trUe. oo
tr. BIG
iz.DATEaIaNro
rs -9 as
INSTRUCTIONS
*correct �1 Ih,f5;la Ea, have been completeo by our omco epeprt!inp to Me iofomtalion on the original record, avert
ConeeUena sod nisi pmtgeon,ara'NOT to be entered In thee* stoups.
2. MST UP/MR da,,oppos dacha ihp (hceirect'ttens, correct Information as It eheuld hove boon pined at the time of death- Plea.. type erpnnt
ratty. If addlno a name InolYde the fvlt dklonai c orr
3,.�AItS•Deneta Mme" Mo( udngartyI !Mddlen eme.lfed ectfonsererequifed, cvntactourocetDPFeparearaNSedaffdm
are generalry conipla►wf by our otfien•
4., READ 1' AFFIbAVIL IT/ !aIglNtS4N U 4 opm PENALTY OF PERgJRY. -.Two different persons who have personal knowledge of the accuracy of TAO
40alre4 Corrocaon(s) must compiet the t4tp hfrIt oolho (Itams 11 though 15, and 16 through 20). The affidavit may be made
8x oIs sur!{�e the (unp*l dfreotorr afnl( member.' by the w to the the em
fi Y etc. Howeve ono 1116 witnesses mum 1» the iorormant. The relsiiasship of the twi6tws to vt0. reglatren
,,mrutt b at8ipd ores`. mother' tether, +wife' "aunt, 'Dhysfcian:' etc. Requests to correct Vie Marital status should be ref�d to the stageaffirm.
,C
IE SfdN M UST AF NOTI•[YI�Ph
0f ID ameeded7Df OO not sign the affidavit excerpt in front of a notary. The slggaaprleo *spurn* complete responsibility for Om
if, w WR ITE t N SI a y 1jejS roue ed forma State Registrar
7. WI$EN!'eOPERLY CQMPLEfEt7 A p SIGNEd 'RPM thIS form 10 the Office of Vitef Records and Statistics, 208 North 1460 We P 0 0ox 1 4 1 012, SIX
'UT e4114.14IE. If D0 lor 40pabl0 51tF1redett ar +Nil •bbYiled end become la Floyanentdan of the oIgkN reevrd.
FSC; -deer* aderltIs comas iedt Wlhlrf yePr ontot! eerier MINK Moro le no fee for Rene It Nowise.. teem N e $.00 fee for the month of the record which Includes
e certified miry emeeeee deetfl f IWO Ow AN DAO year, Mare le e 020.00 fee for rogispanon of rite affidavit which Includes one certified copy of the
tries APPLICANT UO2 II t86PON Tb &W$flTak essloaST FROM THIS COMB wRNIN as CAT& TNS OFFlCE *ILL Remit Alt ROAM; PAM_
7 x DEATH
C ATS N)1M ?EW'; FETAL MEATH e, F AME ,Ib..M OLENAME ""�r- STAINS CERTIFICATE 7EAUfitiBEq
1c.1.AST NAME
INFORMATION AS Helen James v� 1-.i
REPPRTCDmolt, 9 apt a ^DATEaf tw1eNT
mummy,: PLACE OF OCCURRENCE City turd Cowry
REGtsTERED' EE 2't 200 S Ggorc�e Washington
cEATmCAT#.. s NAMIFFATHER
Ai4ie a tl 6 I6- WUOEN NAME OF MOTHER
Catnes
MAKE NO:C4RRECTIQNE ABOVE THIS UNE
OW :As ON THE ORIGINAL RECORD
ly ,oLpaflur, tat I'hav personal knowledge of the
nrtagerl givenfe true and correct.
2 6 ADDRE6d DF W 1 t N E t 1 G 0 1 1 1 m 5 €rata. Zlp)
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t1
Wallace R. Hueys
Wallace Humphreys
o cox L c spelling. of decedents last name fathers last name, ,spouses last name.
Subscribed a S
Notary Public
Subscribed ✓d re m before me this cr Adayof
Relay F.
eb. FACTS As THEY SHOULD HAVE BEEN STATED ON. THE
TTHF TMFf F nccusessDE
Helen James a
^4y oenveic Z di ,y
t l J,A M aEAuLI:U
a" C•EOrir.,E, LT 1)4770
4UR "n EXPP.12.20. 2005
This is to certify that this s a true copy Of hepertficate'on. file 'in this office. This certified copy is issued
under authority of section 26 -2 -22 of the)JtahCi ode Annotated 1953 As Amended.
m Date Issued:
Washin
,n
ri m County Barry E.Nangle
00 ,d DIRECTOR OF VITAL RECORDS
c b R egistrar B
111111 IIII II I III III 11
11 0144 4592 1 4 4 4 5 9 2
TA before tee this
i2 -.Z.a-es
It BEAULIEU
1 mot;.:' ":y9ET•
ST. GE0r11 r
COMM. EXP. 12-2.j