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HomeMy WebLinkAbout965573WHEN RECORDED MAIL TO: Patti Edwards 2161 North 1400 East Provo, Utah 84604 STATE OF UTAH COUNTY OF UTAH I, Patti Louise Covey Edwards, being first duly sworn under oath and deposed, hereby affirm: 1. I am the child of David Irwin Covey, also known as Irwin Covey, and Vashti Louise Covey, also known as Louise Covey, husband and wife, and am familiar with things set forth herein according to my own knowledge 2. That I, Irwin Covey and Louise Covey received title as joint tenants by a Bargain and Sale Deed dated August 13, 1990 and recorded August 30, 1990 as Entry No. 722435 in Book 289PR, Page 220 in the Office of the Lincoln County Clerk in regards to the following described property located in Lincoln County, State of Wyoming: 3. That David Irwin Covey, also known as Irwin Covey, died on May 20, 1997 in the City of Provo, County of Utah, State of Utah, as shown on the death certificate attached hereto and filed herewith. Vashti Louise Covey, also known as Louise Covey, also died on November 30, 1993, in the City of Provo, County of Utah, State of Utah, as shown on the death certificate attached hereto and filed herewith. 4. That said Irwin Covey in said deed is the one and same person identified as David Irwin Covey and described on said attached death certificate. That said Louise Covey in said deed is the one and same person identified as Vashti Louise Covey and described on said attached death certificate. 5. That I, Patti, Louise Covey Edwards, am the surviving joint tenant and owner of the property. Dated this Lots numbered 7, 8, 9, 10, 11, 12, and 13, all of Block numbered Four (4) in LaBarge Townsite, as surveyed, platted and recorded, situate in the County of Lincoln, State of Wyoming. day of :s Patti Louise Covey Edwards AFFIDAVIT OF SURVIVORSHIP 00503 RECEIVED 7/16/2012 at 3:02 PM RECEIVING 965573 BOOK: 789 PAGE: 533 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY STATE OF UTAH :s COUNTY OF UTAH On the day of execute the same. Notary Acknowledgement 2012, personally appeared before me Patti Louise Covey Edwards who 00534 in c My Commission Expires: RANDALL G. SPARKS NOTARYPUBUC•STATE OF UTAH OMMISSION# 576221 COMM. EXP. 10-20-2012 14 si rf 17 911i'6 d 4 1 it tl %111 I i ¢'`;r d CC W a A�F�d ,ei Wi n: CERTIFICATI 0 ITAL RECORD V' L OCAL PARENTS INFORMANT otsrosmopt' 'REGISTRAR' 1 NAME "OFIECEDENT =FIRST YASHTt MIDDLE LOUISE COVEY RATEOF BUT 4. 0egird 0 5 1 :=BB PIACEOFDEATH (Geed& only one)" HOS ITAU', ❑'I CImo DOA ee, >CIIY. TOWN OR LOCATION OF DEATH 10.WASDE(SQENT E W ITS A 135-.R_ESIPENCE STREET AND_ NUMBER 2885 N'. ,ma rorest 13e. I SC CItY, ®Ya_❑ the 131. 211 CODE 34604 S.AGE- ::here •sw yr Yn 11•AURITALBTATUS Nov« Mtu4W Herded D DW02etl D Widowed S3ONATUNE OF RJ Gary -td� 34. MANNER-.D.EDEATM 47 2101 DATE OF'DISPO5Imt4 )1;46 4,, 4993 PART 1LOIMlliaM3eanl:WAdlflau 01cn1,0100.p 10 death b4412"21 m rAdry_ _160 3lnd/rMnpt!(rae pNenaliFp�1' OATS -DF INJURY 1 A OWA. D. Ywr) IF UNDER 20 IODU15 ttu15 /Aumm UNDER 1 YEAR.. Menthe Dwe, O1)ER: NUrshp Nome Rsootula ouw ad. COUNTY OF DEATH Utah 23. LICENSEE NuMBFA_. 63508Q60 35b.'1134E OF_ Female 3LDATE OF DEATH Y,ye. Day. Yp November 30,3993 0. BIRTIPIACE 03M.•Poem /rpn trrreryl Garden Ci ty, °UTAH 12. DECEDENFSUSUAL OCCUPATION (GNIlrbWe1 dufipm011emorkIrc We DoNOTImoTOnd) 1 L, Homemaker 136. CRY. TOWN. 011 COMMUNflY Provo 14. WAS DECEDENT OF ML:PANIC ORIGIN? Yee MINI 15. RACE Biedr. Wtrbe. Am. indan (11 Yes. 5P6dN) 06. vrhrodJ Je Ne. (SDaody) 0 Mexken❑ Cuban 0 Puorp 3kan kte ST FAT) R'S:NAME (Rm. Middle. 441) Nathaniel Hodges 4p NAME, -IIEGTIONS ALUUNG OF IN DaadI: Covey: (Hu band 2885 N ldarores Provo er 1B. MA'IDEM: NAAIiA.1pOTHER..,4R A1;dd) Lae,) arintt* Harcoc, (31b P.L4L'OE ORDISFOSITIOhi4(oedehry p: 4 mory Me oro5Mrp)ea) East Lawn Memorial Cem I Nf)fD8 24 FUNERAL Sun dba R 9ta L N L. r o the T r''' Wee. deStI:oc i4rted,e the timAir ata old plats en doe tQ B 5) 1d rtiei�ne as stored o1CALF)(�1M1 RiFORCEMFt7r `s`0^t w .q ,y, Thos a on anax leveeudeedon, inmy opinion, deethob elereddi&teUma,deLerA�e: and aisl othecause(a) alldmtaurer 276." AND T1RE 13PEPTWFER Utz( -sue Dg9E$S OF_P5R86N WM0 CERTI Flt3) 7N�E, 0„F:DFATH (fl Lt31) Watt-Et,- AD, 1034 Ntit;t`1ik300„ WesrproVo U.T= 84604$ Bb.NAMEOFHOSPITAL NURSING SOMEOR'OTNERFACILITI. NWe acilIK phfsaeWadadua aa1n) 2885 NarthfMarcrest G SP SURVIVING m w)N, pin maiden name) David L _:Covey_ 13c, OUNTY ZTta�i 045 (Name, d n dle& idens tebeA ,pin Morary 495 '7So_ th tam 0rem UT 805 27e._t10EN %NU1 32.:IN- YOUR� Y,( "cc° BY THE DECEDE Pioeegy eprogirtl M musket darner 0 wu l lle uMe ilU.. M OSI1- OTdtrot e0^n er eYaesl deaYl 1011 0101:'. Ok uvuownh .11(nleer ew.:ofd. 1 M.USER 34..h1MEOFDEATM Pete.deele 0200 .SO(rw.sE CDnfidenflal 120 KINDOF BUSINESSORII•IOUSTRY Home_ 13d. STATE_ UTAH 16. EDUCATION (SpndyQ'M'Ml stgrade (1 13 .18 17 2 g ondary LOCATION, +c Iy or Town, Swe Y 0vo tgtah� tet e d: 27d. DME4KiNED 30. 10.CYCFILED (Aknm. EC 0 31 PART 1, DISEASES. OR Y ARREST, S imkiENATE CAS E(FinaI 1 A )s3u]bnp n�d_e `r>u =10 (p 1A5A `qF -roe 9 e •2 up 1D O (1 S Vlf $BGoantla py (f61 bfls'••- 0. T or 5A i- led, W ow aw a EMerUNDERL`Pfl CAUSE or Lyu tlw(iplDetsd svantFrerulb ix. 1C (b1 As'ADONASA ENCE 01]r in deam)IASr. I 336: WERE AUTOPSY F1 GSAVAUARLI:^ PRIG TODOMPtt10N OFCAU$E0FDEATt ir��le 35o�.BJJURY. AT WOR 35d. PLACE OFINJU Y-AIMme farmM4141 Ieclmyr amoe.dWdino. NC 1sMdfjl') 35...LOCATION of nrel route ',umber. emy co town. corny andaere) 35.3. 0 motor ven1J0 accident. tee:KYR deoeder. w.. ddwr. pa2evpu0r pdMM4YYIr.. 3E1.DEsciuseMOW000URRED- (.014 o*no d er.,s *NNAil r NATURE OF INJURY SFIOOL° BE- ENTERED R' 31) UD148vRH3Fonn ••12. Rev.1 1.59 kt Thi is an exact-rep oduction of the_document reglsterecTm_#Tie State Office of titat- Statistics S ecirity:features of this official document include lnfaglto Border,1r&R Images7n top cyyclgids, u ltraviolet fibers and :hologram image of the Utah State-Seal,=-over thewords State of Utahrr. This oc>Jment displays the date, seal and signature. of StateRegistrar and_ihe County /District Health Officer. s. NSW STATE OF UTAH DEPARTMENT OF HEALTH CERTIFICATE O'F DEATH Date Issued: HAR ;08 RIZ STATE FILE NUMBER U MII II 11 I11I11 K 0 3 4 3 2-1 8 4*._ Joseph K Miner, MD, MSPR Director /Huth Offices CountI /DistrictHeaith Depa3thien erur�l 1i ulyuAtt �Jf tt\ /r anlc.e L Houston, State Registrar ffide -tif /j` EdIStBtistics- Jy NP +A� I CCj 17 NA(E OFtECEDENT__FIRST MIDDLE LAST 2. SEX- 3a. DATEOFDEMH (Mo Day_Yd1 &TIME. plir, DAVID IRW_IN COVEY Male May 20.,1997 030 4. DATE, OFBIRTH(A1tk.D1.Y.) 5_AGE(CostBM r tar hday) orn r 1eCEA24 HOURS 6. BIRTHPLACE (C'y a Slate wFUod9n COwrayr' -vroCIAL;LECUR ITT. Monuu °eye Noun 1lm C ti p M ay s 1 902 95 1 Mnes 1 P rovo, UT h Ba PUCE OFOFJtTH (Check o&y one) Be. NAME OF HOSPITAL NURSING HOME OR OTHER FACILITY jtlounldeolo illy HOSPITAL: l OTHER:. p esUeetaddressotIoeaOon) ,kp,LMA 02 ❑3 I 5.Nw.. Hom.. 0 6J1esuenoe 7Oeqn East Lake Care Center d. COUNTY OF DEATH 9, SURVIVING SPOUSE (i wile. 5Wr J9A1 rum.) CITY. TOWN OR LOCATION OF DEATH e DECEDENT 8 L IMPOSITION LorALFnE NUMBEP�J -Q5623 Io.WASDECEI)ENr 11.MAAtTALSTATUS 12 USUAL IJCC 9kup.0l work done EVEFLJt1U.3. �-T during mo ttoiwprki 9il /e 09U eAredJ �MMEOFF Q 1.4 *Tier" U 2:Ma,dod ©1Yet:IS12.No ❑a•Dwc«+ Businessman 136 RE5,10ENCE STREET ANO DUMBER CITY, OR COMMUNITY-, 2885 Marrorest N. Circle Provo 13A INSIDE ;CITY 13t,LP CODE:; CERTIFICATION OF VITAL RECORD .,t,,,s•h11 v .t.+sJ'. at v "gut., ,t ,n M.1.,.,. YV IF. NAME RELA(1oNSHW AND MAI Pat +Edwards (Da h. ,1r slnAll t w bout 5 27a CERTI 40. a 1 ttTOthe besl lOt +',y�,oal T e; 13„1 Mh.1: _w tho caus§(g) 9Ad'rn CERTIFIER t 2 3 lE.+ f nFY r a i 2tu94604 PA iGItJA lash Ib pares PINY a n Covey I s G d tiCAs ITaRY, leading l• pr edialea A S GO cause °EnteTUN' NG t. C'0.USE(disea ind e a Batedeventsr se g DUE TO Sik s omE iAm CAUSE OF^ mdealAJLAST .ems^ EJJI7IL�P,A N6danticoodr Hidin de§ .1 g to m blrt lei Pi,A 9ro NWF n_ I1 1 R: 5t oe •S;SIGNAlW. STATE OF UTAH DEPARTMENT OF HEALTH 14, WAS DECEDENT OF HISPANIC ORIGIN? 01. Yet ®2.No 15. RACE Black; While, An, YWlan 16. EDUCAWN(Spadly (lnas may be entered) Japanese, completod)Elemanlary or Secondary IN vas, spaciy) 0(5 away) (0.12)4049e (1316 or 17.) LIAmIcanLJ2.woan03.R Nta_Rica QA giciA4 ADDRESS_0 INFORMAIT, er) 216t1' Norfh 1400!.>iast; Provo, QT 84624 21a.DA`1E0F01 SITION+I°216: PLACE OP DISPOSIrW�)•(Nd9k�o! 21E:` 01f tr Y, cemelwy. crarnel4ry. wol)taApracp). 'he o, May�24, 1997 Eastlawn Cemetery ate; U 23 U (9 E ?IUM BER rt FUNERAL NAME jNeme addr as erne PG 635 :8060 t Sund a .gjX p.in M ort u acyr 495 ou_ medkA! u ,a..w eQowTO e�{JL I'E'raQ 0re JT TI�51:fP:5!T Akr' ,iz 1 $;i R ef es ear. 32 IN YOUR I11RA000 USE BY TH OECFDENf. Qi.PteneoN' oMwloutede Nrauaa ol eari= �SNON•U 2 We, �dndery,�.ellMc1 de,,, ,t STATE FILE NUMBER (sc.-COUNTY Utah 120.4I1400FBUSINESSORINDUSTRY I'U sine 13tl. $TATS nON• Oy or Tovm, Slato 351. II molot.veNde accident" apedy d docede0 driver, paseanoeror pEd.old,n 1111,111111011111111 O 6 4 3 2 1 8 6 Joseph K. MlnerJADLMSP1'i lousten Registrar Director /Healtlf Officer rtiVStatistid.% County /DlstrictJ!3ealthDepa( 359 .DESCRIBE HOW000URRED(wf...6.. we of «ant. ,41 +no 5.d it airry,.NATURE OF INJURY SHOULD BE ENTEAEDiIN ITEM Thts an eacact:reproduction of :document registered thSt me ate Office of Vita[ tairlstics egu`rity'features of this official document include intaglio BOCder,I/ &=R images In fop cycloids ;'t'' u ra vioE and hologram image of the Utah State dial, offer the words" a OJitah This cument deep eys the date, seal and signature of the Stat #rile Count !District t ealtt Offlcpr !NA O. Al 1. h.tt t! f r Sl l Al M1hh14 A p nit. k ai FIa u a aa up(tli li )I pF T FIE S 7: i 00,7 0 W 5 11 p> k i ea l u t anice t 1 8 9 6 !Is, too fir"r.�,11AI:.: M1I ;1 1 1. I V.?:•c Lg1Ue} .%T