HomeMy WebLinkAbout976324AFFIDAVIT OF SUCCESSOR TRUSTEE
UPON DEATH OF GWEN DIXON BLOMQUIST, TRUSTEE
I, DICK DIXON, being of lawful age and being first duly sworn upon my oath, deposes and
states as follows:
1. That my sister, Gwen Dixon Blomquist was the Trustor of the Blomquist Family Trust, dated
August 6, 1982 and any amendments thereto.
2. That on August 4, 2009, my sister, Gwen Dixon Blomquist died.
3. That I was appointed the executor and personal representative of the estate of my sister,
Gwen Dixon Blomquist and as part of the probate process and pursuant to the trust, I was
appointed to act as the Successor Trustee of the Blomquist Family Trust, dated August 6,
1982 and any amendments thereto upon the death of Gwen Dixon Blomquist, Trustee.
4. That I accepted and signed an Affidavit of Successor Trustee upon the death of Gwen Dixon
Blomquist, Trustee. I am unable to locate that Affidavit but I have been continuing to serve
in that capacity as the Successor Trustee.
5. That I hereby confine my acceptance of the appointment of my sister to act as a Successor
Trustee of the Blomquist Family Trust, dated August 6, 1982 and any amendments thereto.
6. That in confirming my acceptance of that appointment I continue the receipt and acceptance
of all powers, limitations and obligations of a Successor Trustee as set forth in the Blomquist
Family Trust, dated August 6, 1982.
Dated this
day of AL-
DICK DIXON
976324 4/28/2014 3:34 PM
LINCOLN COUNTY FEES: $18.00 PAGE 1 OF 3
BOOK: 831 PAGE: 221 AFFIDAVIT
JEANNE WAGNER LINCOLN COUNTY CLERK
111 1111111111 1 VI 1I II 1 VIII III VIII I I I 1111 !1
2014.
STATE OF UTAH
COUNTY OF Maui
I, DICK DIXON, being first duly sworn, states that I am the affiant noted above, that I have
read the same, know the contents thereof, and tha the statements contained therein are true.
DICK DIXON 7
This Affidavit of Successor Trustee Upon
and sworn to before me this day of
NOTARY PUBLIC
LAURIE GOULDING I
Commission No. 600677 1
Commission Expires
SEPTEMBER 2, 2014
STATE OF UTAH
ss.
N
My Commission Expires:
2
eath of Gwen Dixon Blomquist was subscribed
2014 by Dick Dixon.
Y PUBLIC
CERTIFICATION OF VITAL RECORD
DECEDENT INFORMATION
Date of Death: August 4, 2009
City of Death:
Age:
Place of Birth:
Armed Services:
Spouse's Name: Dale. E Blomquist (deceased)
Industry /Business: Philips Petroleum
Residence: Sandy, Utah
Mother's Name: Sarah Elizabeth. Hurd
Facility or Address: Alta Ridge Assisted Living
INFORMANT INFORMATION
Name: Dick Dixon Relationship: Brother
Mailing Address: 2261 Engelman Place, St George, Utah 84790
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Salt Lake City Cemetery, Salt Lake City, Utah
Date of Disposition: August 7, 2009
FUNERAL HOME INFORMATION
Funeral Home: Larkin Mortuary
Address: 260 East South Temple, Salt Lake City, Utah 84111
Funeral Director: i Robert L Russon
MEDICAL CERTIFICATION
Professional: Danesh Rahimi MD, 508 East South Temple, Salt Lake City, Utah 84102
CAUSE OF DEATH
Dementia Alzheimer [Onset: 5 Years]
Tobacco Use: Did not Contribute
Medical Examiner Contacted: No Autopsy Performed: No Manner of Death: Natural
Date Issued: August 10, 2009
CERTIFICATE OF DEATH
State File Number: 2009021460
Gwen Dixon Blomquist
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
01:23
Salt Lake
January 16, 1920
Female
Widowed
Secretary
Associate Degree
Dick Dixon
Nursing Home /Assisted;Living
ecOF T`�
8E ,;tqi
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x 1 9 g Barry E. Nangle, State Registrar
i Office of Vital' Statistics
2896 f
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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 the Utah State Seal, over the words "State of Utah This
document displays the date, seal and signature of the State Registrar and the County /District Health Officer:
_Gary(t Edwards
Director /Health Officer
County /District Health Department
4