HomeMy WebLinkAbout972661When recorded mail to:
Debra R. Heiner
2407 Thayne Bedford Road
Thayne, WY 83127
AFFIDAVIT AND ACCEPTANCE OF TRUSTEESHIP
Comes now the undersigned Debra R. Heiner, and being on oath first duly deposes and says:
1. That they are a citizen of the United States of legal age and capacity, and competent to make this
affidavit.
2. That 1 was personally acquainted with the deceased, Max Williams
3. That said deceased is one in the same person as Max Williams listed in that certain document as
recorded on April 17, 2000 at Entry No. 865385 in Book 444 at Page 266 in the office of the Lincoln
County recorder, State of WY.
4. That the purpose of this affidavit is for Debra R. Heiner, to accept the Trusteeship of the Max
Williams Living Trust, dated April 5, 2000 and hereby agree to act as Trustee's of said Trust on all
the terms, provisions and conditions specified in said Trust.
5. That a certified death certificate of the deceased is hereby attached.
Legal description:
PARCEL 1
LOT 1 AND LOT 2 OF BLOCK 9 OF THE TOWNSITE OF BEDFORD, LINCOLN COUNTY, WYOMING, AS SAID LOT AND BLOCK
ARE LAID DOWN AND DESCRIBED ON THE OFFICIAL MAP AND PLAT THEREOF ON FILE IN THE OFFICE OF THE LINCOLN
COUNTY CLERK.
LESS AND EXCEPT THOSE LANDS CONVEYED IN THAT QUIT CLAIM DEED RECORDED JUNE 4, 1981 IN BOOK 177PR
ON PAGE 76 OF THE RECORDS OF THE LINCOLN COUNTY CLERK.
PARCEL 2
LOTS 1 AND 2 OF BLOCK 16 OF THE TOWNSITE OF BEDFORD, LINCOLN COUNTY, WYOMING, AS SAID LOT AND BLOCK
ARE LAID DOWN AND DESCRIBED ON THE OFFICIAL MAP AND PLAT THEREOF ON FILE IN THE OFFICE OF THE LINCOLN
COUNTY CLERK.
PARCEL 3
LOTS 3, 4 AND 5 OF BLOCK 16 OF THE EAST ADDITION TO THE TOWNSITE OF BEDFORD, LINCOLN COUNTY, WYOMING,
AS SAID LOT AND BLOCK ARE LAID DOWN AND DESCRIBED ON THE OFFICIAL MAP AND PLAT THEREOF ON FILE IN THE
OFFICE OF THE LINCOLN COUNTY CLERK.
Debra R. Heiner
Dyanna Parker Notary Public
County of ((n"' 1 Slate of
Lincoln i' l�Y Wyoming
My Commission Expires
La .95-is
Notary P a-�`
Commissi€»
RECEIVED 8/14/2013 at
RECEIVING 9726
BOOK: 817 PAGE: 851
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0851
State of WY
County of Lincoln ss:
On lo( August,2013 personally appeared before me Debra R. Heiner the signer(s) of the within instrument,
who duly acknowledged to me that she executed the same.
Date and Place of Death:
Date of Death: September 18 2010
City of Death: Afton
Location: Star Valley Medical Center 110 Hospital. Lane
Additional Decedent Information:
Place of Birth: Emery, Utah
Residence: Bedford, Wyoming
Marital Status: Widowed
Armed Forces: Yes
Name of Father David Henry Williams`
Name of Mother Annie Marie Sorensen::
Informant: Debra Heiner
Disposition:
Method of Disposition' Burial
Place of Disposition: Bedford Cemetery, Bedford, Wyoming
Other Significant
Conditions:
Manner of Death:,
Certifier:
Type: Physician
Name: Allen D. Carter, M.D:
Address: 110 Hospital Lane, PO Box 579, Afton, Wyoming, 83110
Date Filed: September 30, 2010
STATE OF WYOMING
Schwab Mortuary, Afton Wyoming
This is a true certification of the document on file in the office of Vital
�d,' Statistics Services, Cheyenne; Wyoming
CERTIFICATE OF DEATH
92 years
Time of Death 20:30 (Actual)
Gladys K. Breeden
Deputy State Registrar
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141 CERTIFICATION OF VITAL RECORD'
I
Decedent: State File Number: 2010- 002974
Name: Max Williams
Gender Male Social Security Number
Date of Birth: March 15, 1918 Age at the Time of Death:
Friday, October 22' 2010
5. DATE'ISSUED:
R r This copy is not validpolessprepared on paper with ancngravedborder.
County of.Death:
Funeral Home; or Facility:
Facility:
Cause of Death:
The immediate cause is listed pn, the first line followed by any underlying causes.
(a) Pneumonia
Description Original
Date of Death 9/19/2010 9/18/2010
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4 i f l CERTIFICATIO ITAL. RECORD 'Utd
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STATE OF WYOMING
DEPARTMENT OF HEALTH
AFFIDAVIT TO AMEND DEATH CERTIFICATE
This is a true certification of the document on file in the office of Vital
Statistics Servtces, Cheyenne, Wyoming
Friday, October 22, 2010
DATE ISSUED:
This copy' is not valid unless on: paper with"an. engrsed hordes:
Date 10/19/2010
din
Gladys K. Breeden
Deputy State Registrar
J
Name: Max Williams
County of Death: Lincoln
Amendment 1
Signature AllenD. Carter, Attending
Physician
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Affidavit of Correction completed by Allen D. Carter,:; MD :gttending Physician
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State File Number: 2010_002974
Date of Death: September. 18, 2010'x.
City of Death: Afton
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