HomeMy WebLinkAbout965281When recorded mail to:
Kenneth Rowland Lloyd Trust
150 East 8000 South
Sandy, UT 84070
RECEIVED 6/26/2012 at 3:15 PM
RECEIVING 965281
BOOK: 788 PAGE: 328
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
5.. That a certified death. certificate of the deceased. is. hereby attached.
STACEY K LEWIS
NOTAWf PUBUC •STATE OF UTAH
COMMISSION* 605449
COMM. EXP. 01. 25.2015
AFFIDAVIT AND ACCEPTANCE OF TRUSTEESHIP
Comes now the undersigned Betty G. Lloyd and being on oath first duly deposes and says:
1. That I am a citizen of the United States of legal age and capacity, and competent to make this affidavit,
2. That I was personally acquainted with the deceased, Kenneth Rowland Lloyd
3. That said deceased is one in the same person as Kenneth Rowland Lloyd trustee, listed in that
certain document as recorded on 04/16/1990 at Entry No. 716137 in Book 284pr at Page 605 in the
office of the Lincoln County recorder, State of WY.
4. That the purpose of this affidavit is for Betty G. Lloyd to accept the Trusteeship of the Kenneth
Rowland Lloyd Trust, and hereby agree to act as Trustee of said Trust on all the terms, provisions and
conditions specified in said Trust.
Legal description:
Lot 1 of Star Valley Ranch Plat 8 as described on the Official Plat Recorded August 4, 1971 as document
Number 432466 and Map Number 179 in the Office of the Clerk, Lincoln County, Wyoming.
Betty G. oyd Trustee
State of
County of .(1-- ss:
On June•j 2012 personally appeared before me Betty G. Lloyd, and the signer(s) of the within instrument,
who duly acknowledged to me that she executed the same.
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Commission Expires:
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CERTIFICATION O
OF RECORD
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DECEDENT INFORMAT
Date of Death:
City of Death:
Age:
Place, of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Larkin Sunset Gardens, Sandy, Utah
Date of Disposition: January 29 2011
FUNERAL HOME INFORMATION
Funeral Home: Goff Mo
Address: 8090 South State, Midvale, Utah 84047
Funeral Director: Richard A Call
MEDICAL CERTIFICATION
Medical Professional; TAlan Jeppson MD, 105 E South Temple, Salt Lake City (Salt Lake),' Utah "84102
CAUSE OF DEATH
Respiratory Failure
Due to (or as a consequence of): Pneumonia [Onset: 24 Hours]
Tobacco Use: Non user...
Medical Examiner Contacted: No Autopsy Performed: No Manner of Death: Natural
Date Issued: January 28, 2011
ION
January 26, 2011
Salt Lake City
86
Riverton, Utah
Yes
Betty Gogel
Building Construction
Sandy, Utah
Christina Andersen
Salt Lake Regional Medical Center
INFORMANT INFORMATION
Name: Betty G Lloyd Relationship:
Mailing Address: 150 EaSt 8000 South, Sandy, Utah 84070
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,
ultraviolet 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 of Vital Statistics.
CERTIFICATE OF DEATH
State File Number: 2011001056
Kenneth Rowland Lloyd
191
WitiskikiWikk
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
02:10
Salt Lake
January 2,
Male
Married
General Contractor
High School or
Freeman R Lloyd
Hospital Inpatient.
UTAH DEPARTMENT OF HEALTH
Office of Vital Records Statistics
Salt Lake City, Utah