HomeMy WebLinkAbout966393Affidavit of Trustee
I, Darlene Corless :Buckley, being of lawful age and duly sworn according to law, upon my
oath, depose and state:
That under the date November 13, 1997, John L. Corless and Darlene Corless, by deed of
that date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on
November 24, 1997, in Book 4o4PR on Page 518, conveyed to John L. Corless and Darlene
Corless, or their successors, as Trustees of THE CORLESS FAMILY REVOCABLE TRUST
established by Trust Agreement dated November 13, 1997, the following described property
situate in Lincoln County, Wyoming, to -wit:
Star Valley Ranch RV Park Plat 1 Lot 206 as platted and recorded in the official records of Lincoln
County, Wyoming
That by reason of said conveyance aforesaid, John L. Corless and Darlene Corless, as
Trustees of THE CORLESS FAMILY REVOCABLE TRUST established by Trust Agreement dated
November 13, 1997, became the owners of the above described land, and title thereto vested
continuously in said trustees from the date of conveyance described in said deed to the date of
death of John L. Corless, also known as John Lyman Corless, on the 3rd day of February, 1998.
That by reason of and upon the death of John L. Corless, and pursuant to Article 3; Section 3.1 (b)
of said Trust Agreement, title to the above described real property vested in Darlene Corless, as
sole trustee. Darlene Corless married Floyd Dean Buckley on May 1, 1999, and said Floyd Dean
Buckley is deceased.
Affiant avers and certifies that John L. Corless, also known as John Lyman Corless, is the
identical party named as trustee in the aforementioned deed, whose death terminated his interest,
title and estate in said real property; and Affiant attaches hereto and makes a part of this affidavit,
the Official Certificate of Death of said decedent, duly certified by the public authority in which
said death certificate is a matter of record. n
Dated this `U day of 2012.
State of
)ss.
County of J
WITNESS my hand and official seal.
My Commission Expires:
Darlene Corless Buckley, this day of J 9 t
o,2
CHELSEY ELIZABETH PHIPPEN
Notary Public, State of Utah
9 Commission 649127
My Commission Expires
October 26, 2015
00335
a41 14 /2 g.' 2414,4 1 5-(ceir
Darlene Corless Buckley
Subscribed and sworn to be re me, a notary public in and for said County and State, by
2012.
Notary Public
RECEIVED 8/23/2012 at 4:33 PM
RECEIVING 966393
BOOK: 792 PAGE: 335
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
WARNING: IT IS ILLEGAL TO DUPLICATE THIS COPY FOR OFFICIAL PURPOSES.
ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATION.
Access to information On
this form a limbed under
Me Veal 5101011cs AM
Pules LOCAL FILE NUMBER.: 29-•157 -98
and
1 NAME OF DECEDENT "FIRST MIDDLE LAST 2. SEX 3a. DATE OF DEATH (Mo- Day, Yr.) 30. TIME 05 DEATH (24hr.clock)
John Lyman CORLESS Male February 3, 1998 1230
4. DATE OF BIRTH (Mo. Day, Y,.) 5. AGE (usreiirMryl ;IF UNDER 1 YEAR 1F,IR4DER24HOURS 6. BIRTHPLACE (Cily6 Stale or Foreign County) 7. SOCIAL SECURITY NUMBER'
Oct. 10, 1929 68 "n D gn. 1 Minutes Randolph, Utah
89, PUCE OF DEATH Chock only one) Bb. NAME OF HOSPITAL, NURSING HOME OR OTHER FACILITY (If outside a facility,
OTHER`:
Om street address oHocalion)
r..; 1. Inpatient 2- ER/Outpatient 3: DOA $,Nu "rsing Hbme 6. Residence 7, Other McKay-Dee Ho s p i to 1
89, CITY. TOWN OR LOCATION 05 DEATH 5d: COUNTY OFDEATH 9. SURVIVING SPOUSE ('9101,959 maiden name)
DECEDENT Ogden Weber Darlene Ellison
10. WAS DECEDENT 11. MARITAL STATUS 12a. DECEDENTS USUAL OCCUPATION (Give kind of work done 12b. KIND OF BUSINESS 09 INDUSTRY
EVER IN THE U.S. p� during most of wonting 61e. Do NOT use retired)
ryf ARMED FORCES 1. Never Marned A 2. Married
M1. Yes 0 2Nb 03.Wreowed D 4. Likened Branch Chief Defense Depot Ogden
13a. RESIDENCE. STREET AND NUMBER 135, CITY, TOWN OR COMMUNITY 139. COUNTY 134, STATE
2519 North 575 East North Ogden Weber Utah
139. INSIDE CITY 131, 2(P CODE 14, WAS DECEDENT OF HISPANIC ORIGIN? 15. RACE Black, White, Am. Indian 16. EDUCATION (Specify only highest grade LIMITS? (N yes, Spe9dyj'. 1. Yes ®2. No (Tribe maybe entered), Japanese, completed) Elementary or Secondary
etc. (Specify) (0 -12) College (13.16 or 17
1, Yes 2.NO 84414 z Mexken p`, Cuban Q a,PVe4e Rioan 4. Other (Seedy) White 12
17, FATHER'S NAME (51151, Middle. La0I( 18, MAIDEN NAME OF MOTHER (First, Middle, last)
PARENTS Lawrence Corless Goldie Conley
19. NAME, RELATIONSHIP AND MAILING ADDRESS 1=•
or
INFORMANT Darlene E. Curless /,wife "19 North 575 East North Ogden, Utah 84414
20. METHOD OF DISPOSITION 210. DATE DISF,OSITION 2151- PLACE OF DISPOSITION (Name of 21c. LOCATION City or Town, State
I. Entombment 2. Donation 3. Ch Lindquist 's Washington
Other cemetery, crematory, or other place)
DISPOSITION I%14.Bsrial 5.Cvenwden ❑6Remov01 :Feb- 8, .19.98 Heights Memorial Park Ogden, Utah,
22. SIG URE OFF ERAL SERVI UCEN EE 23, LICENSE NUMBER 24. FUNERAL HOME (Name, 344,005 and license number)
102929 Li North Ogden Mortuary #42
25. DAT DECEASED AS LAST 26 f 51Y rlktle a( examiner, was deahraponed,oM,E.? 1 Yes No 2140 North Washington Blvd.
ATTENDED BY CERTIFV enter the d ale;s nd hn0r reported: M.E. Case No. No Ogden, Utah 84414
1 L t l DAY YEAR
273. CE F IER
1. CFRTIFYING PHYFIC(AK To the best 0! my knowledge, death occurred at the time, date, and place, and due 10 the cause(s) and mariner as stated,
CERTIFIER 2 MFDICAI EXAMINER) I AW ENFORCEMENT OFFICIAL On the 035(0 of examination and /or investigation, in my opinion, death occurred at the time,
date„ 5(900, and due t0 558 cause(s) and manner 00 utated.
le.
270. AND TITLE O� CERTIFIER hl- C) 273 LICENSE NUMBER 27d. DATE SIE�(h)o..
28. NAME AND ADDRESS 0 PERSON WM0 0ER7IF( D CAJSEAJSE OF DEATH !I7EMJp (r)parponI) 6
Gary K. G MD 42,5/Eat 5350 South Washington Terrace, Utah 84405
29. REGISTRAR'S SIGNATUR 30a. DATE REGISTRAR NOTIFIED OF DEATH (MO.,Day,Yr.) 30b. DATE FILED (Mo.; Day, 19.1
REGISTRAR FEB 09 1998
31, PART 1 ENTER THE DISEASES INJURIES, OR COMPL(GATIONSSHATCAUSED THE DEATH, DO NOT ENTER THE MODE OF DYING, SUCH AS CARDIAC Approximate Interval:'
OR RESPIRATORY ARREST. SHOCK, OR HEART FAILURE LIST ONLJONE SE ON EACH LINE. Between Onset and
1 1)
Death.
IMMEDIATE CAUSE lFinat 1,�'`.'r`.�1h` (l\1
d9essb or condition
10509.195191010) DUE,TO AS O
Sequemi1.5 1110 00099905, b DUE TO (OR AS A CONSE!ENCE 0 1 'r`rVk w
11 any, leading to Immediate cause. Ether UNDERLYING
CAUSE (disease M injury c
hMiniu'alede1Ms,.000I10 DUE.TO (OR AS A CONSF,OUEN F5
CEO
In
CAUSE OF PART II, Other Significant Conditions to death but not 32. IN YOUR OPINION, TOBACCO USE BY THE DECEDENT 33a. WAS AN 330. WERE AUTOPSY
resph In cau5 rve l ad 1 0.i. Probabl y contributed to the cause of death. AUTOPSY FINDINGS AVAILABLE
DEATH 1I�"'� 1 I Q 5. NON-USER PERFORMED? PRIOR TO COMPLETION
A Y /\.f;Y2Y) 0 2 1 Was the underlying cause of death. M, OF CAUSE 05 DEATH?
3'4. 6 unknown in relation to the cause of death F USER UNKNOWN 1. Yes 1,y 2. No t Yes .1..No
34. MANNER OF DEATH 35a. DATE. 05 INJURY' (Md., Day Ye) 35b. TIME OF INJURY 35c. INJURY AT WORK? 354. PLACE OF INJURY At home, 53n5, street. factory.
Q 1. Natural to 2. Accident (24 Hour Clock) office. bs(ding,elc. (Specify)
1.Yes 2. No
35,. LOCATION'(Sneet Oi nn5I j oule numbs,. dryer town. county ar,00Ite.) 351. If motor vehicle accident specify it decedent was
3. Suicide 4. Homicide driver, passenger or pedestrian.
5. Undetermined 6. Pending
11 injured Invesfigatiob
Purposely or
Accidentally
UDH- BVRHS•Ferm 12, Rev. 1196
This is to certify that this is a true copy of the certificate, oh file in this office. This certified copy is issued
under authority of section 26-2-22 26 -2 -22 of the Utah Code Annotated 1953 As Amended.
01 Date Issued: U 9 1998 s 2
1 County WEBER Barry E. Nangle
00 er- 21P.t..D RECTOR OF VITAL RECORDS
a Registrar
'SjATE OF UTAH DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
STATE FILE NUMBER