HomeMy WebLinkAbout975025AFFIDAVIT OF TRUST
1. That I am a successor trustee of the Metta H. Stauffer Revocable Trust
dated October 9, 1997.
2. That on November 13, 1997 in Book 404PR, Page 119 of the records of
the Lincoln County Clerk was recorded a Quitclaim Deed from Metta H. Stauffer to
Metta H. Stauffer, Trustee of the Metta H. Stauffer Revocable Trust dated October
9, 1997 conveying the following described land:
Commencing 8 rods North of the Southwest corner of Lot 2 of Block 14 in
the Afton Townsite, Lincoln County, Wyoming, thence North 6 rods, thence
East 10 rods, thence South 6 rods, thence West 10 rods to the point of
beginning.
ALSO
Beginning at a point 2 rods East of the Northwest corner of Lot 1 in Block 14
in the Afton Townsite, Lincoln County, Wyoming and running thence South
12 rods, thence West 12 rods, thence North 12 rods, thence East 12 rods to
the place of beginning.
Excepting therefrom the land described in Warranty Deed recorded
September 19, 1972 in Book 101PR on page 199 of the records of the
Lincoln County Clerk.
Excepting therefrom the land described in Warranty Deed recorded June 30,
1992 in Book 312PR on page 262 of the records of the Lincoln County Clerk.
3. That Metta H. Stauffer died on September 29, 2013 as shown on the
certified copy of the decedent's death certificate attached to this Affidavit
and, pursuant to the provisions of said Trust, T. Paul Stauffer is the
successor Trustee.
State of Wyoming
)ss
County of Lincoln
I, T. Paul Stauffer, do solemnly swear that I have read the foregoing Affidavit
subscribed by me; that I know the contents thereof and verify believe the
statements therein contained are true.
January, 2014 by T. Paul Stauffer.
Witness my hand and official seal.
My commission Expires:
T. Paul Stauffer
J
T. P
ul Stauffer
Subscribed and sworn to (or affirmed) before me this l day of
Notary Public
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City of Death ;:Bountiful:
.Age 92
Made of $irtlt.. Groveland „Idaho
Awned Services No
Spouse's Name Claud:Hughes Stauffer`
Industry' %Business At horn:
Residence: Bountiful, Utah''
Moth is Name Mary Ann Amanda Peterson
Facility or Address: Lakeview Hospital
INFORMANT 1NFORMATION
Name: T Paul Stauffer Relationship:
Mailing Address: P.O. Box 65, Afton, Wyoming 831%0
dance L Houston,
000 ofVital Statistics
1111R. 1
;;2013
E :ICATE OF DEAL
M Fite Number: 2Q13012066
Metta Stauffer
Time of :Death:
County of Death:
Date of Birth
Sex;
Marital.Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:.
D ISPOSITION INFORMATION..
Method, of Disposition Removal,
Place of Disposition Afton cemetery Afton, Wyoming
Date of Disposition September 21, 2013'
1.
FUNI=RAL HOME INFORMATION
Funeral Hom: Rn B
ussorothers Mortuary B
e. ul
Address: 295 North Main, Street, ;::Bountiful Utah :84010
*Funeral Director: Brent C •Rxisson
M EDICAL, CERTIFICATION
Certifying, Physician Charles D WhiteMD 46 Capecchi pave,;440. Medical Drive, Salt La
08.'3
Davis
October 24, 1920
Female.
Homemaker
Associate Degree
Ernest Frederick Hale
Hospital Inpatient
is R. Garr
irotor /1#ealth icer..
Countyfljistrict Health,Dep'artment
CAUSE OF'DEAtN'
Right Hip Fracture
.::Dtli6r'significant conditions: Dementia; Chronic: Renal' Inadff
Tobacco Use Non -user
Medical Examiner Contacted Yes Autopsy Performed N o Mannerof Accident
INJURY INFORMATION
Dato of Injury::.
In}ry at
Location of Injury,
How I
Motor Vehicle Accident:
te;4 egistered :;;September 2:5 20;1:
ate :Issued S eptemfber:2.5, 2013.
September 15, 2013 Time of injury
No Place of Injury:
1150 South Main, Bountiful (Davis), Utah
Patient Fell From Bed
No
This is an exact reproduction of the facts registered in the Utah State:Office of Vital Records and Statistics
`"n'! 1 i1�9q Security fearaules of this official document lnelude Intaglio. Border, V R;images in top cycloids, anti intagli mi
pr� r u ■4 V"% This document displays:the date, seal and signature of the Utah State Registrar andthe :County /Distnct Health Offic
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