HomeMy WebLinkAbout973898STATE OF WYOMING
ss.
COUNTY OF LINCOLN
I, PAUL C. SORENSEN, Personal Representative of the Estate of Robert Edwin Sorensen
being of legal age and first duly sworn, depose and state as follows:
1. Alicia Joy Sorensen the decedent mentioned in the attached certified copy of the certificate
of death, is the same person as Alicia J. Sorensen named as one of the parties in that certain
Warranty Deed dated April 13, 1977, executed by Edwin Sorensen and Lorna R. Sorensen
to Robert E. Sorensen and Alicia J. Sorensen, his wife, as joint tenants with full rights of
survivorship and not as tenants in common, recorded on May 2, 1977 in Book 135PR at Page
630 as Instrument No. 492455, of the Official Records of the Lincoln County Clerk, State
of Wyoming and described as follows:
2. As Personal Representative of the Estate of Robert Edwin Sorensen and son of Alicia J.
Sorensen, I am a person interested in the effective property or the title thereto and pursuant
to 2 -9 -102 W.S. (1980) hereby make the death a matter of record and certify that upon the
death of Alicia J. Sorensen, her previous estate in the property was terminated.
3. The certified copy of the certificate of death indicates that Alicia Joy Sorensen died on May
17, 2011 in the City of Salt Lake City, County of Salt Lake, State of Utah.
Dated this
STATE OF
All of Lot 54, Palis Park Subdivision according to the official plat on record
in the Office of the Recorder of Lincoln County.
day of ta,
ss.
COUNTY OF .3 &V
This Affidavit of Survivorship was subscribed and sworn to before me by Paul C. Sorensen,
Perso al Representative of the Estate of Robert Edwin Sorensen, this /7 day of
6J ,2013
RECEIVED 10/29/2013 at 1:08 PM
RECEIVING 973898
BOOK: 822 PAGE: 875
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
AFFIDAVIT OF SURVIVORSHIP
2013.
PA L C. S SEN, Personal Representative
Estate of Robert Edwin Sorensen
NOTARY PUBLI
My Commission Expires:
/02 Oh 7
EVA PARRY
Notary Public State of Utah
My Commission Expires on:
November 20, 2013
Comm. Number: 580
08 75
CERTIFICATION AL RECORD
MEDICAL CERTIFICATION
DISPOSITION INFORMATION
Method of Disposition: Cremation` Place of Disposition: Neil O'Donnell Sons Crematory, Salt Lake City, Utah
Date of Disposition: May 23, 2011
FUNERAL HOME INFORMATION
Funeral Home: Neil ODonnell Sons Mortuary
_Address: 372 East 100,South, Salt Lake City,, Utah 84111
Funeral Director: Michael P O'Donnell
Janice L. Houston State Registrar•
Office of Vital Statistics
N
CERTIFICATE OF DEATH
State File Number: 2011006039
Alicia Joy Sorensen
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
10:22
Salt Lake
September 24, 1932
Female
Married.
Homemaker
High School or GED
Unknown Unknown
Hospital ER
Husband
Medical Professional: Robe
r4 G Parker, DO, 3725 West 4100 South, West Valley City (Salt Lake), Utah 84120
CAUSE OF DEATH
Natural disease otherwise unspecified
Other significant conditions: Hypertension; Hyperlipidemia`
Tobacco Use: Non -user
Medical Examiner Contacted: Yes Autopsy Performed: No Manner of Death: Natural
Date Issued: May 24, 2011
AMENDMENT HISTORY
05/24/2011 Conditions. Contributing to Dea rom Hypertension; hypo lipemia to Hypertension; Hyper Lipidemia
05/24/2011 Conditions Contributing to Dea from Hypertension; Hyper Lipidemia to Hypertension; Hyperlipidemia
Date of,Death:
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Mother's' Name:
Facility or. Address:
INFORMANT INFOR
Name:
Mailing Address:
This is an exact reproduction of the document registered, in the State Office of Vital Statistics.
Security feature�of this official document include: Intaglio Border, V R images in top cycloids,
```%A
ultra violet fibers and hologram. image of the Utah State Seal, over the words "State of Utah This
.0••• �`�)i document displays the date, seal and signature of the State g
istrar and the County/District Health Officer.
DECEDENT INFORMATION
May 17, 2011
Salt Lake City
78
Kaunakakai, Hawaii
No
Robert Edwin Sorensen
Own Home
West Valley City, Utah
Daisy Joao
St. Mark's Hospital
MATION
Robert 'E Sorensen Relationship:
4660 West 4695 South, West Vaiiey City, Utah 84120
Trion IflII1 IIII
Gar i(k Edwards
Director /Health Officer
County /District Health Department
1