HomeMy WebLinkAbout975721STATE OF Utah
COUNTY OF Utah
Affidavit of Death
I, MARY C. HEALEY, residing at 556 S 450 E, OREM, Utah 84058, being of legal age, depose
and say that:
That ROBERT D. HEALEY, 556 S 450 E, OREM, Utah 84058 died on April 25, 2007 as
evidenced by a certified copy of the Certificate of Death, attached hereto;
That decedent owned the following property described in the real property deed attachedreto
and incorporated herein;
That I am the successor to the estate of the decedent and tct the decedents interest in the described
property and no other person has a superior right to the interest of the decedent in the described
property;
That no proceeding is being or has been conducted in Utah for administration of the decedent's
estate;
That the funeral expenses, expenses of last illness, and all unsecured debts of decedent have been
paid.
Oath or Affirmation:
I certify under penalty of perjury under Utah law that I know the contents of this Affidavit signed
by me and that the statements are true and correct.
1% March 12, 2014
This Document is beiil rode. by
RockyMountain Tieelesunonce Agency
of Lincoln County as a GouRTESv only
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975721 3/27/2014 12:48 PM
LINCOLN COUNTY FEES: $21.00 PAGE 1 OF 4
BOOK: 829 PAGE: 539 AFFIDAVIT
JEANNE WAGNER, LINCOLN COUNTY CLERK
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STATE OF UTAH, COUNTY OF UTAH, ss:
This Affidavit was acknowledged before me on this 12 day of rft-r-ik,
H by MARY C. HEALEY, who, being first duly sworn on oath according to law, deposes
and says that he /she has read the foregoing Affidavit subscribed by him /her, and that the matters
stated herein are true to the best of his /her information, knowledge and belief.
MICHAEL DRAPER 1
NOTARY PUBUC•STA7EOFUTAH
Notary Public
coMMissi0N# 653401 Title (and Rank)
COMM. EXP. 03.052016
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My commission expires 3 5 'L°' 40
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CERTIFICATION OF VITAL RECORD
ISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Orem City Cemetery, Orem, Utah
CAUSE OF \DEATH
Uncal and tonsillar herniation [Onset: 3 Hours]
d ma, bilateral'
Subdural hernato [Onset: 6 Days]
Coagulopathy [Onset: 1 "Week]
Atrial fibrillation; Coronary artery disease
Tobacco Use:,: Non-user
Medical Examiner Contacted: No Autopsy Performed: No Manner of Death: Natural
DATE ISSUED:
STATE OF UTAH
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IIII 11111 III 1 II 11 I III
Barry E. Nangle, State Registrar 0 6;1 3 6 4 8 8 9*
Office of Vital Statistics
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Date of Disposition: April 30, 2007
This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V R images in top cycloids,
ultra violet fibers and hologram image of a hawk over the word validThis document displays the
date; seal and signature of the State Registrar and the County /District\Health Officer.
Updated Utah State Seal replaces hawk over valid for authenticity.
G x-14-4 K7
Joseph K. Miner
Director /Health Officer
County/District Health Department
DECEDENT INFORMATION
Date o f D April 25, 2007
City of Death: Provo
Age, 77
Place of Birth: Alpine, Utah
Armed Services: Yes
Spouse's Name: Mary Colleen Hutchings
Industry/Business: Small Business
Residence: Orem, Utah
Mother's Name: Margretta Ann Stephens
�acil y
i or Address: Utah Valle •.Regional Medical Center
NFORMANT INFORMATION
Name: Colleen Healey Relationship:
Mailing; Address: 556 South 450 East, Orem, Utah 84097
FUNERAL HOME INFORMATION
Funeral Home: Walker Sanderson Funeral Home
Address: .646. East 800 North, Orem, Utah 84097
Funeral. Director: Thomas E Sanderson
CERTIFICATE OF DEATH
State File Number: 2007004863
Robert D Healey
41 Q4 J�k1^kYd^kM•44lr
Time\of Depth:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
23:26
Utah
February 7, 1930
Male
Married
Business Manager
High School or GED
Richard Winn Healey
Hospital Inpatient
MEDICAL CERTIFICATION
Certifying: Physician: Edward J Campbell MD, 1055 North 300 West Suite 501, Utah Valley Pulmonary Clinic, Provo, Utah 84604
rantu Dub
THIS INDENTURE, made this I5th day of February ,19 95
by and between LEISURE VALLEY, INC., a Corporation organized and existing under
and by virtue of the laws of the State of NEVADA, duly authorized to do business in the
State of WYOMING and having its principal place of business in the County of Lincoln,
State of Wyoming, the GRANTOR, and
R.D. Healey "1990 Trust" dated March 12, 1990
Robert D. Healey and Mary C. Healey, Trustees
of the County of 11tah State of 1 Jtah
the GRANTEE, whose address is 556 So. 450 East
Orem. 11T R405R
WITNESSETH: That the GRANTOR, for and in consideration of TEN DOLLARS'
($10.00) in hand paid, the receipt whereof is hereby acknowledged, does, by these pres-
ents, grant, bargain, sell, CONVEY AND WARRANT unto the said GRANTEE, all that
certain tract, lot, piece, and parcel of land situate in the County of Lincoln, State of
Wyoming, hereby releasing and waiving all rights under and by virtue of the homestead
exemption laws of the State, to -wit:
STAR VALLEY RANCH RV PARK PLAT ONE (01) LOT TWENTY -FOUR (24) as
platted and recorded in the Official Records of Lincoln County, Wyoming.
;6.00
Recorded..Maxgh...2.1.,.. at y'lo lH
In Book., 366PR p Kemmerer, WY.
No 99 Marsha Moe, Clerk
RESERVING THEREFROM all rights, title, and interest in and to any and
all minerals and rights appertaining thereto.
Subject to all declarations of covenants, conditions and resrictions of record.
IN WITNESS WHEREOF, the Grantor has caused its corporate seal to be hereunto
affixed, and these presents to be signed by its duly authorized agent, the day and year
first above written.
.144;.tii•
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3
STATE OF Nevada
COUNTY of Clark
Witness my hand and official seal.
My Commission expires•
The foregoing instrument was acknowledged before me by Craig A. Stewart
By
authorized agent of Leisure Valley, Inc., a Nevada corporation;
this 1 5th day of February 1925
Notary Public -State 01 Nevada
COUNTY OF CLARK
A M GARCIA
My Commission Expires
April 7. 1998
LEISURE VALLEY, INC.
A Nevada Corporation
c, a-(S ,w9
Authorized Age t
a duly