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State of U4 k
County o
I, \t Y\ Q`�'�1'�'J11
(type or print your name)
N th c VoN)
(Insert 'Executor of the Estate "Administrator of the Estate" or "Next of Kin
of Lou Sorenson
who was a resident of the State of U at the time of death, do hereby swear that
there is no necessity for a formal* administration of the Estate of Lou Sorenson in
the State of WYOMING
(Insert State(s) Wherein Oil Gas Interests are held)
That is, that all debts of the Estate owing to creditors in said state(s) have been discharged and there are
sufficient assets outside said state(s) to satisfy all other debts of the Estate and legacies under the Will, if
any. Further, no probate /succession or formal administration is contemplated.
Subscribed and sworn to before me this 4 day of T/�t/y 201 /-7
Notary Signature
SHERRY LYN CUSTANCE
''a'' L NOTARY PUBLIC •STATEOFUTAH
w` I. rl 'Yf COMMISSION# 674031
COMM. EXP. 02 -04 -2018
JEAN WA GNE R LI COU NTY CLE
111111 I1 II II 11111 III 111 IIII IIIII I II I IIII 1K
11 11 I1I
AFFIDAVIT
STATE OF UTAH
COUNTY OF UTAH
SUBSCRIBED AND SWORN /AFFIRMED TO BEFORE ME
ON THIS �3 DAY OFJGa .20
,.S f
BY 5 iALSaiyDy P tuC 7/�
NOYP IC
177728 7/28/2014 10:34 AM
977�� -JLN COUNTY FEES: $15.00 PAGL JF 2
BOOK: 836 PAGE: 688 AFFIDAVIT
in my capacity as
My Commission Expires: t;Z 9 o2Cl
jh�� Z
NUM >(Y PUBLIC
"Formal" administration occurs when a court issues "Letters of Administration" and appoints an Administrator
to settle the affairs of the deceased.
�I23�
SHERRY LYN CUSTANCE
NOTARY PUBLIC. STATE OF UTAH
Qs
°r� COMMISSION# 674031
4 X0:;;9 COMM. EXP. 02 -04 -2018
OF
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DENT
DateofDeah May
gitSiOf Death: Lehi'
85
EvafiStomi yOing
"de O.;; idtv
O'dif e
s: s'.N4m6:::::::',.
Indust Education
/Lehi, Utah.
Offer!s.Naiti.e:•••
arifY-.:or .472,: :40:g0:14Orft)
Li!41 DAT
mbe rizai140
Lou N. §PrePsOR
iNilnf:•••toi.,t".:44rrAtOtitk:SOrensoiil
t.RAL
nraI Home Wing IffMo..M:Ja
Add ress 0E Street IA)
.•furieral Director:
Dat6:o irt
r.
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INFORMAN13100ikMg.t.160.:
D6611is'Nkte:Sorenson''' Reiationship•-•
aifi#0.Addrbss::,:••••••. .:',.293 Lehi.,-.LItah
,s.........:.:.:":: ,...:•'„-,:j.• :.•;:i:;:
•Ii4170100tilNfpRIVATION:::
Me •of?..PIPOPli BuriA
Place of DiSpoSitiah''k:1 LehkOtV,Cerilef6iiy,::?.6 i
:49''Of•Disppsitiorc.•,..7, May 27, 2014
.00 *,171 N
EJ o coa WeSt,q=216asan
Tirte.of.Death. 00:00
County P.I.Pb:E.:
Seg Ten16
Mtatiiis:::: 6Wed:'
kat:: Occupation Teacher
Education -TS.achelor'spegree
Father's tIame Francis Leroy Narram
Attack [Onset 1 0
(pr4a cos eggap .17.1ypertensiOrgonse.t... 25 Year.j
80,
'Y..."Other significan
.76$atco:UsaY
er Contacted Yes u Performeci Manner of Death Natural
a eRegi"Stere y 28,, 2014.
atelesued:Nlajt 2 2014
001 TYPSg:„