HomeMy WebLinkAbout975479NTL -66936
When recorded mail to:
Lisa Alberston
722 Oakwood Drive
Heber City, UT 84032
JULIE C. GILES
Notary Public
State of Utah
Commission Expires 09. 27-20
COMMISSION NO. 601163
975479 2/28/2014 2:45 PM
LINCOLN COUNTY FEES: $15.00 PAGE 1 OF 2
BOOK: 828 PAGE: 642 AFFIDAVIT
JEANNE WAGNER, LINCOLN COUNTY CLERK
I IIIIIII IIII I IIII IIIII IIIII II II III Ill IIIII II II IIIII IIIII IIII II I III IIII IIII
AFFIDAVIT AND ACCEPTANCE OF TRUSTEESHIP
Comes now the undersigned Lisa Albertson, 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, Orris E. Albertson
3. That said deceased is one in the same person as Orris E. Albertson listed in that certain document as
recorded on October 2, 2002 at Entry No. 884506in Book No. 500 at Page No. 603 in the office of the
Lincoln County recorder, State of WY.
4. That the purpose of this affidavit is for Lisa Albertson to accept the Trusteeship of the Orris E.
Albertson Trust dated March 12, 2001 and hereby agree to act as Trustee 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:
ALL OF LOT 32 OF THE VIOLA SUBDIVISION, PHASE 1, LOCATED IN LINCOLN COUNTY, WYOMING, AS
DESCRIBED ON THE OFFICIAL PLAT THEREOF, FILED JULY 8,. 1983 AS INSTRUMENT NO. 600082 IN
THE OFFICE OF THE LINCOLN COUNTY CLERK.
Previous order #64256
Liar
Lisa Albertson
State of UT
County of (!t')Chct{z{ ss:
On F..e .-b. 24,, 2.01 L f personally appeared before me Lisa Albertson, and the signer(s) of the within
instrument, who duly acknowledged to me that They executed the same.
CEDENT::tNFORMATION
:Date of Death April 22,; 2011
City of Death: Heber
Age; 78
P lace of Birth Aberdeen Washington
.Mined :Services_: No.:::::.
Spous Name:`
Industry/B:asiness_
Residence:
Mother's Nae
m,
Facility or Address
?.ate Registered :May 3, 2011.
gate Issued February 27, 2014
Rev.:603
Wastewater Treatment
Heber, Utah
Margaret. McNamara
:722:Eas Driive
antce L. Houston;:
State Registrar.
QF: DEATH
tate``F'i >011PQ1985r':=
rI FQRMAN:T.iNFORMATION;
Name: Lisa Hilievi:Albertson y Relationship;
Malting Address: 722 East Oakwood Drive, Heber, Utah :84032
i
Orris Earl Albertson
Time kbeath:
County of Death:
Date of Birth
Sex:
Marital Status.
Usual Occupation: :
Education
Father's Name
Facility Type.
SPOSITION INFORMATION>
ethod oft ispnsitidr: Donation
Place of disposition: University of Utah Body Donor Program; Salt Lake City, Utah
Date of Disposition: April 22, 2011
I :N:ERAL HOME °INFORMATION
Funeral Hobe Unrversity of: Utah Body;Donor Pro
Address 20.North_ 1900 East,:$aft Lake City, Utah 84132
Funeral Director Kerry Dort :Peterson
MEDICAL CERTIFICATION
Medical Prgfesstonel;:; S McDonald MD; 35 South 500: East, Heber (Wasatch
CAUSE OF: :DEATH»
Acute M Leukemia [Onset: 3 Months]
Due to (ores a consequence of): Myelofibrosis [Onset 6 Years]
Tobacco Use Unknown if User
Medical Examrner. co ntacted No ;;:Autopsy Pe formed, N M anner of peath: Natural
22:08
Wasatch
March:5;
;:Male`
:Divorced:'
Engineer
Master's Degree
Irvin:Earl Albertson
Horne
Randall K. Probst
Director /Health Officer
County /Dlsti t:I1ealth Department
This is an exact reproduction of the facts registered •n theUfah state of Vtal fiecords and Statistics
�yi�, Security features ofthis pffictat ncl
document Iude Intaglio Border; V &R images in top cyclotds, and intaglw migrotext
=if e F Xj� p T att, is documend
t isplays the date seal and signature of the Utah State Registrar and the Couniy/DistricttHeaklf:Offioer.
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