HomeMy WebLinkAbout967273AFFIDAVIT OF TRUST
1. That I am a successor trustee of the Doug Evelyn Hardy Trust dated
May 26, 2004.
2. That on October 25, 2004 in Book 570PR on page 657 of the records of
the Lincoln County Clerk was recorded a Quitclaim Deed from Douglas W. Hardy
and Evelyn L. Hardy to Douglas Woodford Hardy and Evelyn Louise Hardy, Trustees
of the Doug Evelyn Hardy Trust dated May 26, 2004 conveying the following
described land:
Lot 79 of Star Valley Ranch Plat 16, Lincoln County, Wyoming as
described on the official plat filed with Instrument No. 514467 of the
records of the Lincoln County Clerk.
3. That Douglas Woodford Hardy died on July 30, 2010 as shown on the
certified copy of the decedent's death certificate attached to this Affidavit
and, pursuant to the provisions of said Trust, Evelyn Louise Hardy is the
successor Trustee.
State of Utah
)ss
County of Utah
I, Edo of mHly I have read the foregoing Affidavit subscribed by me;
that I know the contents thereof and verify believe the statements therein
contained are true.
Evelyn Louise Hard'
Subscribed and sworn to (or affirmed) before me this 5 day of October,
2012 by Evelyn Louise Hardy.
Witness my hand and official seal.
My commission Expires: V\
RECEIVED 10/9/2012 at 2:21 PM
RECEIVING 967273
BOOK: 795 PAGE: 727
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Evelyn Louise Hardy
NOTARY PUBLIC
DIANNAH R BROWN
656447
My Commission Expires
May 30, 2016
STATE OF UTAH
Notary Public
00727
DECEDENT INFORMATION
Date of Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry /Business:
Residence:
Mother's Name:
Facility or Address:
Date Issued: August 9, 2010
July 30, 2010
Orem
92
Salt Lake City, Utah
Yes
Evelyn Louise Moncur
San Jose State University
Orem, Utah
Clara Louise Holmes
153 West 1520 South
Barry E. Nangle, State Registrar
.O.ffi.ce..af_V. ital_Statistics_
o d ta2av w
CERTIFICATION OF VITAL RECORD
epartment
CERTIFICATE OF DEATH
State File Number: 2010008822
Woodford Hardy
INFORMANT INFORMATION
Name: Evelyn Louise Hardy Relationsnip�
Mailing Address: 153 West 1520 South Qrem Utah 84058
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Orem City Cemetery, Orem, .Utah
Date, of Disposition: August•6, 2010
FUNERAL HOME INFORMATION
Funeral Home: Sundberg Olpin Mortuary
Address: 495`'Sot;ith State,'Orem Utah 84058:
Funeral Director: Kel`Iy C Sundberg
MEDICAL CERTIFICATION
Medical Professional: Jeffrey. Ogden MD; Orem Internal Medicine, 142.1
CAUSE OF DEATH
Pneumonia [Onset: 2'Weeks]
Due to (or as a consequence:of): Dementia [Onset _1'Year]
Due to (or as a consequence of): Aspiration [Onset 1 Month]
Tobacco Use: Unknown.: if User
Medical Examiner Contacted: No Autopsy Performed:
x
Time of Death: 08 :30
County of Death: Utah
Date of Birth June28, 1918
Sex: Male
Marital Status: Married
Usual Occupation: Professor
Education: Master's Degree
Father's Name: William Woodford Hardy
Facility Type: Home
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
ultra violet 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 and the County' /District Health Officer.
11111 [11 III 11
Joseph K. Miner, MD, M$PH
Director /Health Officer
\County/District Health
90728