HomeMy WebLinkAbout891277BOoK 5~PRPAGE-~-4 J~--
Affi da ~i~) d) f2T~ uqs t e e
RECEIVED
LINCOLN COUNTY CLERK
I, Bonnie ,Jean Olsen, being of lawful age and duly sworn according to
law, upon our oath, depose and, state:
That under the date of January 26, 1979, by deed of that date, which deed
was duly filed of record in the Office of the Lincoln County Clerk, on August 21,
2001, in Book 451 of Photostatic Records on Page 019, a life estate was granted
to LaVere Johns and Deon K. Johns, in regards to the following described
property situate in Lincoln County, Wyoming, to-wit:
Commencing at the South West corner of Lot No. Four (4) in Block Seven (7) in
the Town of Alton, State of Wyoming, and running thence North Ten (10) rods,
thence East Three (3) rods; thence South Ten (10) rods, thence West Three (3)
rods to the place of beginning
That LaVere Johns life estate in the said property was terminated by
affidavit recorded April 11, 199! in Book 295 of Photostatic Records on Page
523.
That the life estate ceased upon the death of Deon K. Johns, on the 19th
day of April, 2003, and title to the above vested absolutely in Bonnie Jean Olsen,
as trustee of the Deon Johns Irrevocable Trust, dated September 8, 1991.
Affiant avers and certifies that Deon K. Johns, also known as Wilma Deon
Johns, is the identical party named in the aforementioned deed whose death
terminated her interest, title and estate in said real property; and Affiant attaches
hereto and makes a part of this affidavit, a copy of the Official Certificate of Death
of said decedent, duly certified by the public authority in which said death
certificate is a matter of record.
Dated this,.~o-z~day of~ ,2003.
~ean Olsen
State of Utah )
)SS.
County ofr
Subscribed and sworn to before me, a notary p~bl.i,c in and for said County
and State, by Bonnie Jean Olsen, this ~)a ~"'day ofI I.~ ~,~,.~.~.., ,2003.
WITNESS my hand and official seal.
..,: ,.-:--._ CAROL J. ASTLE
. ,:i '~'~'i~)695 EAST 1000 NORTH
· ..~>~'i'~....~.~? LOGAN, UT 84321
i '"CZ;:Y;i;'!;/My Comm. Exp Aug. 28, 2004
My Commission Expires:
Notary Public
STATE OF UTAH ~ DEPARTMENT OF HEALTH
~,':~"%~'";'~=~""'": ' ' CERTIFICATE OF DEATH
~nd:l~.,~!!~t LOCAL'FILE NUMBER O 3 -- 0 4 6 STATE FILE NUMBER
:;:r: :,.~i~~ 1. NAME OF, DECEDENT FIRST MIDDLE LAST : 2 SEX ~ 3a DATE OF DEATH (Mo., Oay, Yr.) 3b TIME OF DEATH (24 hr. dock)
'~ ~ ':'' wilma Deon :JOHNS FE14ALEl Feb. 11, 2003 0215 .
520344-0089
· ~': < ~> check o,ly ~1, Inpatien[ ' ~ 5. Nursin0 Home : ~ 6. Res~e~e (any) { (il o~side a la~, g]~ ~t a~e~s ~ ~b~) , ', 3 ....
. , , ~ , ~ En ombmen ~ 2. Dona on ~ 3. O~er , · .
- : ,..: '2 .N MEANOADDRES80 P~RSON~R~EDTHECAUSEOFO~TH ~31 ~¢f) .
REG ST~R ~ ' : ' ' (Mo Day Yr) e
· ?'~[~:' ~?: :'::~ ~,~;~:~{,:::;~' .?;:O~ RESPi~TORY ARREST, SHOC~'OR H~T ~URE_ OST:0HLY ONE CAUSE ON ~CH LINE ' '. I ~n On~t a~
' , ' ::' diseaseoibonditionmsu~ng a, ' ~ % ~ ~ ~])lfE'~ [/I%-~Y~ ~UV~k~ 6&~J %
: '%:. indeath)" d , · DUETO OR~ACO~SEQUENCEO~)~ - g
;~ ;~ '~';; ~U~ ~is~seo/~nu~mat ' ' ,. DUE TO (OR AS A CONSEQUENCE OF ~ [ ~ -- · a
' D A~4' : .. - ~.1: Pr~ ~ to ~e ~use of ~alh. ~5. NON USER ' ' ' PRIOR TO COMPLET ON
..' ~3.9~alo~useofdealh, ~6. UNKNO~ ~ I Yes ~2 No ~' Y~s ~2 No
· ~DH:B~', :. ,injur~ , Invest~ 3~.DESCRIBEHOWINJU~O~CURREO(enter~e~msuB~inin~,NA~RE~INJURY~I)'
F~12
APR 2~ i 2003
This is to cei"tif~;t't~t ihis'iS a true copy of the certificate on file in this office. This certified copy is issued
und~i; at~ih0ri.ty .d!!:¢~¢tio~'2~6;2;22 of the Utah code Annotated ].953 As Amended.
County ' BEAR RIV:E~; HbAL
-
Barry E. Nang e
DIRECTOR OF VITAL RECO~ /
Registrar
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