HomeMy WebLinkAbout978385 64117 l 978385 9/12/2014 12:52 PM
LINCOLN COUNTY FEES: $21.00 PAGE 1OF 4
lc kman BOOK: 839 PAGE: 507 AFFIDAVIT
,L and tleco JEANNE WAGNER, LINCOLN COUNTY CLERK
SINCE 1904 1 111111 111111111 111111111111111110 1111111111011 111111111 11 1 111 11111111
AFFIDAVIT
I, MARILYN H. ROSE, being first duly sworn on oath, depose and say:
That I am a citizen of the United States of America over the age of 21 years, and a
resident of UTAH
That I was well and personally acquainted with CALVIN M. ROSE one of the Trustees
of the Calvin and Marilyn Rose Family Trust, Dated March 29, 2006 in that certain Warranty
Deed dated March 29, 2006 and recorded April 6, 2006 in Book: 616 at Page: 367 as Filing
No. 917273 in the office of the Recorder of Lincoln County, Wyoming.
That I know of my own knowledge that CALVIN M.ROSE in the said deed and
CALVIN MANFULL ROSE mentioned in the attached Certified Copy of Certificate of Death
was one and the same person.
This affidavit is intended to terminate the Trusteeship of said CALVIN M. ROSE, as
Trustee of the CALVIN and MARILYN ROSE FAMILY TRUST, Dated March 29, 2006 said
Trust in the following described property:
All of Lot 7 and the West 1 /2 of Lot 8, Alpine Pines Subdivision, Lincoln County, State of Wyoming, as
shown on the official plat thereof, filed and recorded in the office of the County Clerk of Lincoln County,
State of Wyoming
Tax Roll No. 12- 3718- 29 -3 -13- 062.00
LH
64117
41—
WITNESS, the hand of said grantor, this it ID day of August A.D. 2014.
in and s�,..
MARILYN H. ROSE?ustee
UV TRUSTEE ACKNOWLEDGMENT
STATE OF W om
SS
County of Lnc_oi n
On this 31 of August A.D. 2014 personally appeared before me, MARILYN H. ROSE, known to
me to be the Trustee(s) of the CALVIN AND MARILYN ROSE FAMILY TRUST, DATED MARCH
29, 2006 and the Trustee(s) who subscribed the said Trust name to the foregoing instrument,
acknowledged to me that they executed the same in said Trust name, and that said Trust executed the
same.
Commission expires: L --au I L l� 1 1.441.6 CM-
Residing in 1_4`n r "4-‘j Notary Public
VICKIE MUNSON NOTARY PUBLIC
County of I. fir: State of
Lincoln Wyoming
MY COMMISSION EXPIRES: 26 Dec. 2016
LH
64117
WITNESS, the hand of said grantor(s), this c i day of .4SkS E A.D. 2014.
MARILYN H. OSE
INDIVIDUAL ACKNOWLEDGMENT
STATE OFvrin :n1
SS
County of Ll'ir
On thee' da y of A ,,,As 1' A.D 2014 personally appeared before me MARILYN H.
ROSE the signer of the with who duly acknowledged to me that she executed the same.
Commission expires: 1 "c3 LL1-4—; 1 a t L4Ar .0 a
Residing in: L, Notary Public
VICKIE MUNSON NOTARY PUBLIC
Coun of
Linco
n State of
Wyoming
MY COMMISSION EXPIRES: 26 Dec. 2016
LH
o 1I [4. 6 4 i 1V r c :a, SL7 s l j 1. i..3�Q 4, i�t$ b +p
+i� A SSTAT (,�F UrT�H� N ti y iu g y+w
t. ',CERTIFICATION`OF VITAL RECORD a i u Q
y yy p� yr, 1
CERTIFICATE OF DEATH
i •cir era
1
State File Number:,2013000845
Calvin Manfull Rose
is t DECEDENT INFORMATION
Date of Death: January 16, 2013 Time of Death: 07:00
City of Death: Bountiful County of Death: Davis
IN Age: 78 Date of Birth: July 13, 1934
0 Place of Birth: Bountiful, Utah Sex: Male
Armed Services: Yes Marital Status: Married
Spouse's Name: Marilyn Holiist Usual Occupation: irrigation
Industry/Business'
Residence:
City of Bountiful Education: 9th Through 12th Grade
Bountiful, Utah Father's Name: Wallace Rose
Mother's Name: Della May Manfull Facility Type: Home
Facility orAddress: 265 East 2100 South
INFORMANT INFORMATION
f Name: Marilyn H Rose Relationship Wife
Mailing Address: 265 East 2100 South, Bountiful, Utah 84010_
DISPOSITION INFORMATION
ki t Method of Disposition: Burial
01 Place of Dis osition Bountifu[ C-i Cemete Bountiful Utah_
to Date of Disp sition ty
Januar�Z21,2013
FUNERAL HOME INFORMATION
Funeral Home: Russon Brothers Mortua Bountiful
Address: 295 North Main Street, ,Bountiful, Utah 84010
kt411 Funeral Director: Brent C Russon
MEDICAL CERTIFICATION -_T
Medical Professional:; Joseph Jensen MD 425 Medical Driv Bountiful Davis),- Utah 84010
CAUSE OF DEATH
Small Cell Cancer of Lung [Onset: 4 Months]
Tobacco Use: Probably Contributed
Medical Examiner Contacted: No= Autopsy Performed No Manner of Natural
_Dte Registered; January 23; 2013
Date Issued: January 23, 2013
;.4 1! -1
Thls Is an exact reproduction of the document registeredinthe State Office of Viiial`Statistics.
Security features of this official document include Intaglio Border, V R images In top cycloids,
k\k, Alu;lii ii ultra violet fibers and hologram image of the Utah StateSeal, over the words "Stale of This
hp, document isplaysthe date, seal and signature of the State Registrar and the County /District Health Officer. "�t CO
i OF TIC 114
.c
IIf III 111 III 1 11111111 11
rep w s R Garr a k o Janice C H o uston r S t a t e R egistrar O 6 6 6 4 4 4 7 tor /Health facer •y
vG t t� ,1 Qffice of vital State §tics County /District NealthDepartrrrent .7..0 t e
ii i c =i <Y
HSl".,. r' kAtr, Abib4 4; t1,^ 1,, t d; YkydAd# k kkdk y y.. Fkt ik3 e k El it' yy. d�dkkdSddkktkf5A E' kb!Bi6At sAtYbk�k4:,iJ sot{ �kY� Y,I�.+krkxelkl��x7'x6 x l l n:. '1<