HomeMy WebLinkAbout97935164199
979351 11/17/2014 2:36 PM
1 LINCOLN COUNTY FEES: $18.00 PAGE 1OF 3
u m BOOK: 843 PAGE: 490 AFFIDAVIT
j t t JEANNE WAGNER, LINCOLN COUNTY CLERK
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=sINce 1904
AFFIDAVIT
1, KARLA D,VASE, being first duly sworn on oath, depose and say:
That I am a citizen of the United Status of America over the age of 21 years, and a
resident of LOUIS ANA
That I was well and personally acquainted with MICHAEL S. VASE one of the Trustees
of the MICHAEL S. VASE REVOCABLE LIVING TRUST DATED OCTOBER, 20, 1992 in
that certain Warranty Deed dated November 23,1992 and recorded. November 30,1992 in Book:
321PR at Page: 10 as Filing No. 757713 in the office of the Recorder of .Lincoln County,
Wyoming.
That I know dray own knowledge that MICHAEL S. VASE in the said deed and
MICHAEL SHAUN VASE 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 MICHAEL S. VASE, as
Trustee of the MICHAEL S. VASE REVOCABLE LIVING TRUST DATED OCTOBER 20,1
992 said Trust in the following d.escribecl property:
Lot 246, Lakeview Estates, Tract "A a Subdivision of the S' /2SE`/ of Section 29, Township 37 North,
Range 118 West, according to that plat of record in the Office of the County Clerk, Lincoln County,
Wyoming
Tax Roll No 12- 3718 -29 -4- 17-062.00
LH
64199
Dated this S' day of November 2014 A.D.
STATE OF LA
SS
INDIVIDUAL ACKNOWLEDGMENT
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County of O s
On the g0 day of November AD, 2014 personally appeared before me KARLA D. VASE
the signer(s) of the within instrument, who duly acknowledged tome that she executed the same.
Conixnission expires: Oki" De
Residing in: `j Pa��z� Note "iiblic
D1;061414 iliFtsi "bilottri
Vase LAST
2. SEX
Male
3s. DATE OF DEATH (Mo. Day, VD pb TIME OF DEATH 04 hl stack)
Oct 16, 1993 I 02:18
T. bArE OF CI F174174 ?la', 7/ i
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ts Trigto 1.1, ipunsl G 011111IPLACE IC o• a s ale so roman CJ 11 SOCIAL SECURITY bIL/170417
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Rock Springs, Wyoming
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09. NAME OF /10SINTAL. NURSING I lOME OR 0171ER FACIITY Dinulsk10 i Iiissitily.
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LDS Hospital
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Mary Joan Gazaway
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This 191 1•8 et oir.:.titt000triy s8 t f'tOII 19 thls office. This certified copy is issued
idi1tft .t'' 2 of thU91Itis ikrfrt,otatod, 1868 As Amended.
4(1. 4
Wh
Wear,
Date lakkit
3
11
11
11
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91 091 UTAH bEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
'Wry a>NIMVO
b.int OF VITAL RECORDS
At 0 0 9 Li 8 5 11
e
11
11
S FILE NUMBER
1 4 3 9 3 _008 4 9
1
00.00 0'O U. 0 0001. wan r. WW1 I,u?,tp rCCg1I,1ts!r1I
ritqlgri WI WARIVING; IT IS 11.1.E6AL TO bt/PLI(/10E THIS COPY FOR OFFICIAPPURPbSES
41111m. °R Y.9,J THIS C 91 I ITI ,FA CATI°14 i'., Ultaitatunh,,,
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