HomeMy WebLinkAbout973482When Recorded Mail To:
Hy Dillman Hunsaker, Trustee
L. B. Hunsaker Family Trust
2258 Jennings Street
Woodbridge, VA 22191
I, Hy Dillman Hunsaker, state as true and accurate:
Date this
1. That Lorin Barnard Hunsaker, the decedent in the attached copy of the
Certificate of Death is the same person as Lorin B. Hunsaker aka L.B.
Hunsaker, Trustee of the L. B. Hunsaker Family Trust Agreement dated 27
day of May, 1993, named in that certain Quit -Claim Deed, dated the 27 day
of May 1993, and recorded on the 24 day of June, 1995, in Book 371 PR
Page 290, Kemmerer, Wyoming, No. 805573, transferring the following tract
of Land in Lincoln County, State of Wyoming:
Lot 26 in Livingston Subdivision, (Section 19), Township 37 North,
Range 118 West, 6th P.M., Lincoln County, Wyoming.
GEO #37181940502500; 390 West Cottage Lane, Alpine, WY
2. That Hy Dillman Hunsaker, aka Hyrum Hunsaker, 2258 Jennings Street,
Woodbridge, Virginia, 22191, is the successor Trustee of the L.B. Hunsaker
Family Trust Agreement dated 27 day of May 1993.
4 day of August, 2013.
STATE OF VIRGINIA
COUNTY O PRINCE WILLIAM
On the day of August, 2013, Hy Dillman Hunsaker, Trustee, L. B. Hunsaker Family
Trust, ersonal1 ap e s c e me and signed this instrument.
Notary Public
Number:
My Commissi
MOHAMMED MANIUL HASAN
Notary Public
Commonwealth of Virginia
7501499
1Dffitialtknission Expires Dec 31, 2015
AFFIDAVIT OF DEATH
a ?Y; 1 (AX"- 0 4 s itsfLAI (A it
Hy Dillman Hunsaker
Executor, Estate of Lorin Barnard Hunaker
Trustee, L.B. Hunsaker Family Trust
0415
RECEIVED 9/30/2013 at 9:15 AM
RECEIVING 973482
BOOK: 821 PAGE: 415
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
WARNING: IT IS ILLEGAL TO DUPLICATE THIS COPY FOR OFFICIAL PURPOSES.
'P"77 ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATION. �7T
1. .NAME OF DECEDENT' FIRST "MIDDLE %7'LAST 2. SEX 3a. DATE OF DEATH (Mo., Day, Yr) 3b.TIME OF DEATH (T46r, amd)
Lorin B,azga ;S3i,, `i r 1j}ypsaker Male Dec 9, 2001 0730
4. DATE OF BIRTH(Mo De 7r) 5 /AGE Last Bfr53e)' j 'IF UNDER 1 YEAR IF UNDER 24 HR$ 6. BIRTHPLACE (City State or Foreign Country) ?,SOCIAL SECURITY: NUMBER
j i i M0nJpg Days Hours .I Minutes
Apr 28, 1927 74% j Brigham City, UT
8a. DEATH I HOSPITAL (sofas mdesfefospeI oily) I ALfiOTNEr}.'LOCA�IONS 8b. NAME OF HOSPITAL, NURSING HOME OR OTHER FACILITY'
(check only I 1 Inpai ent I a 5 in r 444 ❑6: Residence (any) (Ifoufslde 8 /aciNty, give street address of Walton)
one) fl 2,EWQurPatient poA /bY��,( Hy Brigham Nursing Rehabilitation Center
8c. CITY, TOWN OR LOCATION OF DEATH y? 1 8d ";go,(IJTY DEATH 9. SURVIVING SPOUSE(d maiden n
Brigham City ,8QX i1der LuDeen Wayman
DECEDENT 10. WAS DECEDENT 11. MARITAL STATUS DECEDENTS USUAL. OCCUPATION (Give kind of work done 125. KIND OF SI S
EVER IN THE U.S. during most of working life. Do NOT enter retired) LIMY
FORCES? 0 Never Mamed Q 3 W)doweg i
D1. Yes 2'1,4° ®2, Married 4 divored c E for
it /i, News Paper
139. RESIDENCE STR ET. ANDNUMBER 135.: CITY, TOWN, OR COMMUNITY 13c COUNTY 13d STATE
345 South 200 West Brigham. City Box Elder UT
13e. INSIDE CITY 131. ZIP CODE 14; WAS,DECEDENT'OF 1. Yes 2. No 15. RACE- Black, White, Am. 16. EDUCATION(sp.o .Ny wow
LIMITS? (yesjS c3) W
Indian (MU may be entered), grade Elemetary or
Japanese, etc. Specity) S000nda tY( 0.12 Col
1. Yes 1. k�exi �/n ag'e(13 -16
7/ /2.� or 174)
2. No 84302 �'3 Py.rSq n b 4'oir
White 17
PARENTS 17. FATHER'S NAME (FNS(, Middle: La N) 18. MAIDEN NAME F MOTHER (Firs( Middle, Las(
Hyrum Barnard Hunsaker Ethel Rose
INFORMANT 1e' NAME, RELATIONSHIP AND MAILING ADDRESS OF,IM ORMANT
Hy Hunsaker S 2258 Jennings Street, Woodbridge, VA 221914403
20, METHOD OF DISPOSITION 218 ?DATEOF TISPOSITION 21b. PLACE OF DISPOSITION (name of cemetery, 21c. LOCATION City`or Town, State
Z ciematoty, oroBrorplace)
Pee 01. Entombment 0 2, Dg)ution 3' Other
V DISPOSITION )1
4, Burial 5. Cremation 8, Removal
,Ojj� ,�y5 2 0,p1 Brigham City Cemetery Brigham City, UT
a 22. SIG R E OF SERVIC LICENSEE' G i 3 3. LICENSEE NUMBER 24. FUNERAL HOM (Name and address)
C
113970 Myers Mortuary 101696
E". 25. DATE DE SED WAS 5T 26 H nOt certified by Medical sel Was death reported b M.E.?
ATTENDE YCERTI GP If yBS enlef �dal8 and hdllfep0rled) 01. Yes ®2. No 205 South 100 East
W /Z 0i M t:ASE�4 4% HR r Brigham City, LIT 43
802
27a. CERTIFIER r!,
1. CERTIFYING PHYSICIAN:
CERTIFIER 0 2. MEDICAL EXAMINER 1 CAW ENFORCEME(JT FFICIAt on f b 'Sin or axerek,a0,n and/or investigation, in my opinion, death occurred at the cart,., date, plane and due la the
causes(.) and manner as Ma i j
27b. SIGNATURE AND TITLE TI 27c: LICENSE NUMBER 27d. DATE SIGNED (Mo., Day, Yr.)
n 831701161205 /2-'
D 28, NAME AND ADDRESS 0 �SO H CER IFIE GAUSE ("DEATH (ITEM 3 drif)
1)/Type4'
Lynn Q. Bear M D, ,9,13 So1;h 5,Q.
u „S' West, Brigham City, UT 84302
29. REGISTRAR'S SIGN EE /7 30.. DATE REGISTRAR NOTIFIED OF DEATH 30b. DATE FILED (Mo. Dag (03
REGISTRAR 7IG�C r .r (Me., nr, rr) r•
nr. n 9nnT Dec 21, 200 1
31, PART ESPIRATORY 1 ARREST SHOCK OR HEA r R t om/ 7 NLY ONE 84t/SE ON EACH LINE Behve i gooroxei Onseate In t And
terval
IMMEDIATE CAUSE
OR R AIL
L`$T`0 i Death.
Final.
disease or condition resulting a. I(.� 1 2 ws
In death) r, DUE TO ,(OR AS A;CONSEOUENCE OF):
DUETO (CR AS A CONSEQUENCE 09:
Sequentially lit conditions, If
any, leading to Immediate i 2
cause, Enter UNDERLYING DUB= (OR AS A,CONSEQUENCE OF): I
Initiated at d events resulting sultin IN g Inthat i 1,2% i, i
death) LAST d i
C,',/ 4i!
PART II. Other Significant Conditions contributing to death/ 32: IN Y OUR OPINION, TOBACCO USE BY THE DECEDENT 339. WAS AN AUTOPSY 33b: WERE AUTOPSY
CAUSE OF but not resulting in the undedying'cause gjven In Pad 1 PERFORMED? FINDINGS AVAILABLE
DEATH f 1. Probably contributed to 9,. cause M death. NON -USER PRIOR To COMPLETION
j is 2 Was the underlying cause of death. OF CAUSE OF OFATN?
i dr/rp( contdbule 50th. cause of death. B. UNKNOWN 01. Yes ®2. No 0 1. Yes 2. No
A Is unKnoNi(in relation la the pause of death, IF USER
34. MANNEI(,GF DEATH 354,'DATE OF( JURY Mo /Qa)J� 355: TIME OF INJURY 350. INJURY AT WORK? 35,5. PLACE OF INJURY -At home, tmh sbee4 factory,
(24 Probably contributed
0 office, bullding, eta. (Specify)
.Natural 02. Accident i ii; 1. Yes 2. No
35e4L0CpT� N (S Ltir rely route nu h"' bar, ci ty or foes, minty and state.) 351. If motor vehicle accident, iy H decadentWas
03: Suicide �4;Homklda i driver, r passenger or pedestrian.
UDH -BUR If inure 5. Undetermined 6. Pending t
d Investigation 35g.
Form 12, DESCRIBE HOWJURY OCCURRED(enfersequenca olevenfs which resulted in injury, NATURE OF INJURYahovk/ emeredM 31).
Purposely or
Rev. 12/98 Accidentally
Date Issued:
e 0
e Auks
This is to certify that this is a true'copy of thecertf�r�te %n'f(1 this office. This certified copy is issued
under authority of section 26 -2 -22 of the Utal`f'`Cod 1953 As Amended.
Y1 A/
County
AN 2 7 2002
RegisfiarH k VEF HEALTH DEPT
LL893772
LOCAL FILE NUMBER'. 0 2- 2 2 9 /C ERTI F ICA i t uF 'DEATH STATE FILE NUMBER
try E.,Nang
l' b
�CTOR OF VITAL RECORDS
By
WARNING: IT IS ILLEGAL TO DUPLICATE THIS COPY FOR OFFICIAL PURPOSES.
ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATION.
WANtdi
INFORMATION
AS REPORTED
ON THE
ORIGINALLY
REGISTERED
CERTIFICATE
02 -229
LOCAL CERTIFICATE NUMBER
County
to
RegistIrrAR RIVER HEALTH D
t II R977R
j/�E DAVIT T,C� AMEND A RECORD
O BIRIH /6 DEATH'' O FETAL DEATH
2. SEX
Male
5. NAME OF FATHER 4,"
Hyrum Barnard Hunsaker
MA.10E N'0. CpBIf`.'�CTION`S�ABOVE THIS LINE
S a A i G 85. FACTS AS THEY SHOULD HAVE BEEN STATED ON THE ORIGINAL
N UITEM R FACTS EXACT AT THE TIMEOFOCCURRENCE
216 B Ci•tl Cerr<e'terv Honevville Cemetgry
21c Rri.a City. IIT Hnneyvill Utah
STATEMENT ,�mt
OF
AMENDMENTS 2 6,2
WHYIS CHANGE L Wrnnr� ramPtPry Al/' 2i W4 NECESSARY9 a U¢% r
I h cattily, under penalty of perJury that I have perso
Subscribed sworn to before we 155 3 da y of
oa� wledp��e o(Ihm above tads and that the
Information given Is true and correct,
Notary Publ"lb. c d4uf
70. qFFSTW RNESS i 4 ri DATE SK3NED: r OATHOF s s" Af1 WITNESS 12. FWITNESS 11 RELATIONS HIP OFW )TNESSTO E L 9 WASI4NGTON
r 1SBEINOAM L� r OGDEN.UI'BOd04
4
`t' I A COMM COMM. EXR 12- 12-2002
14. ADDRESS OF WITNESS (street, dly, alala xp)
226 ?ern/n9s S'}ree lUgoa J ZZ1gl 't4o L
1 hereby candy, under penally of pel(ery that !have persona dWledga of the above lads and thal Subscdbed sworn b- ore me this day of +r�
Information gNen above 5 true and eouec1 i
Notary Public
15. O TURE OF SECOND WITH 4 j p %DTI 1 SIG N ED
SECOND /1-1-d°( 1 �is�L, d� .i iV 3 o�OO a S REED iMYERs
WITNESS 17. AGE WITNESS RELATION oFWRNEssTo ,J�IE PERSON WHOSE RECORD E jar q aN
5 ISBEING'AMEfSED G� i M6WA8liNGTON
oTioEN.ure4.o4
16. ADDRESS DEWINESS (street, dry.s ip) ••t.- �yy� C i< C OMM EJ(R 12-12-2002
UDH "BVR•a Rev. 5 (f CO ULC1�T L L
W��il l P lr �(�p L
FOR USE OF 20. DATE ACCEPTED q q 21:'OF THE ST E OR IIE 41; 1/nnny��^' j�
ST R O STRAR JUN 2 1 2002 j I I, J
This is to certify that this is a true copy pf the pert fOate ott flle k this office. This certified copy is issued
under authority of section 26 -2 -22 of the Utal0; ode'Aftildtated, 1 953 As Amended.
rn Date Issued' ,J
rry E,;Narg e
ECTOR OF VITAL RECORDS
ba/ /aS�2c
STATE CERTIFICATE NUMBER
Hospital (II applicable)
DECLARATION OF HY DILLMAN HUNSAKER
I, Hy Dillman Hunsaker, personally appear and render the following as true and faithful
declarations:
1. I was born May 1, 1955, to Lorin Barnard Hunsaker, aka L. B. Hunsaker, and Dorothy
Dillman. My birth certificate was issued by the State of California and reads "Hy
Dillman Hunsaker." I was named after my paternal grandfather, Hyrum Barnard
Hunsaker, and have used the name Hy and Hyrum throughout my life. For legal matters,
I use the name found on my birth certificate. It is the name on my drivers license and
work documents. However, in personal matters the Hunsaker family often calls me
`Hyrum"
2. In the document creating the L. B. Hunsaker Family Trust Agreement dated May 27,
1993, the successor Trustee is identified as Hyrum Hunsaker, the son of the originally
named Trustee, L. B. Hunsaker. This document was drafted by Lorin Hunsaker's cousin,
Jack Molgard, an attorney licensed in the State of Utah. The document employed the
name L. B. Hunsaker rather than Lorin Hunsaker; and when both Lorin Hunsaker and
Jack Molgard used the name Hyrum Hunsaker, they intended to identify Lorin
Hunsaker's son, Hy Dillman Hunsaker.
3. The will of Lorin Barnard Hunsaker names Hyrum Hunsaker as executor. Again, this
will was prepared by Jack Molgard and both Lorin Hunsaker and Jack Molgard intended
to identify the testator's son, Hy Dillman Hunsaker.
4. I, Hy Dillman Hunsaker, affirm that I am the individual identified in Lorin Barnard
Hunsaker's will, trust documents, and other legal documents as Hyrum Hunsaker. There
is no other living individual who would be identified as Hyrum Hunsaker and be the son
of Lorin Barnard Hunsaker.
G(iti Signed 3 day
L�t. Si ed this
Hy Hunsaker of August, 2013.
2258 ennings Street
Woodbridge, VA 22191
State of Utah
County of Salt Lake
NOTARY PUBLIC
MEUSSA GARRETT
582065
COMMISSION EXPIRES
MARCH 22, 2014
STATE OF UTAH
On the day of August, 2013, personally appeared
before me Hy Dillman Hunsaker, and duly executed this
Instrument.
Notary Public
My commission expires: 3
0418