HomeMy WebLinkAbout968701AFFIDAVIT AND ACCEPTANCE OF TRUSTEESHIP
Comes now the undersigned Dewain H. Jenkins 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, Carma A. Jenkins
3. That said deceased is one in the same person as Carma A. Jenkins listed in that certain document as
recorded on October 16, 1985 at Entry No. 644689 in Book 232PR at Page 194 in the office of the
Lincoln County recorder, State of WY.
4. That the purpose of this affidavit is for Dewain H. Jenkins to accept the Trusteeship of the Dewain H.
Jenkins Family Trust dated July 26, 1985 and hereby agree to act as Trustee of said Trust on all the
terms, provisions and conditions specified in said Trust.
5. That a original death certificate of the deceased is hereby attached.
Legal description:
A TRACT OF LAND LOCATED IN THE NW'Y4NE' /4 OF SECTION 33, TOWNSHIP 35 NORTH, RANGE 119 WEST OF THE 6TH
P.M., LINCOLN COUNTY, WYOMING, SAID TRACT BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHEAST CORNER OF THE NW'/4NE'/4 OF SAID SECTION 33 AND RUNNING THENCE WEST 20
RODS; THENCE SOUTH 68.5 RODS; THENCE EAST 20 RODS; THENCE NORTH 68.5 RODS TO THE POINT OF BEGINNING.
State of WY
County of Lincoln ss:
One l day of Decmeber, 2012 personally appeared before me Dewain H. Jenkins, and the signer(s) of the
within instrument, who duly acknowledged to me that They executed the same.
Dyanna Parker Notary Public
Mate of
Wyoming
County of
Lincoln
My Commission Expires.
RECEIVED 12/27/2012 at 3:12 PM
RECEIVING 968701
BOOK: 801 PAGE: 374
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Dewain H. Jenkins
0037.
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onwood Street, Murray, Utah
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DECEDENT INFORMATION
Date of Death: February 29, 2012
City of Death: Murray
79
Age:
Fairview, Wyoming
No
Dewain Haderlie Jenkins
At home
Centerville, Utah
Margaret Lovina Barrus
Intermountain Medical Center
Place of
Armed Sentioes7.
Spouse's Name:
-iIndustry/Business:
Residence:
Mother's Name:
Facility or Address:
ifik AV. W Wii 15 WO OWL 1./1 Will WIN We lil I lir
CERTIFICATION OF VITAL RECORD
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ate March 12, 2012
CERTIFICATE OF DEATH
State File Number: 2012002684
arm Rene Jenkins
Time of Death:
County of Death:
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INFORMANT INFORMATION
J.i Relatedttip
Mailing Address. 670 East45:40 North, Centerville. Utah ,84014
DISPOSITION INFORMATION
Method of Disposition: Burial
place Centervilie Cernetery, C Utah
Date ofniscid March 5.2012
7
CAUSE OF DEATH
Septic Shock
Due to (or as a-consequence of):'
Toliacco Contribute--
Medical Examiner Contacted: t 3/ Performed. No Manner of De
Autopsy
15:30
Salt Lake
August 1
Female
77
Usual-AapicupationiFlomemaker-
Education: Some College but No Degree
Fathers Name: Harvey Rich Allred
Facility Type: Hospital Inpatient
Husband
FUNERAL
u
F neral Home: Rtitton*othere Mortuary Boun tiful
ful
Address: 295 North Main street, Bountiful, Utah 54010
Funeral Director: Brent Ci
IVIEDIGALERTIFKATION
Medical PrbletsionOr, Frank Thomas M5riii_internounta_in_ MedicaiCenter, 5 outh-
8415r-
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This is an exactreproduction of the document requittered iti_the State Offite of Vital
Security features of this official document include hitagth:i images in top cycloids,
ultra violet fibers and hologram image_of the Utah Staie_Seal,=over the words "State ofiltalf This
document displap the date, seal and signature of the State istrarrd the Countyfflistrict Health Officer.
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Janice L. Houston, State Registrar 06 33 7 6 8 0
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Salllake VallOy Health DejYartment
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