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Home My WebLink About20063178.tiff 869 RESOLUTION RE: ACCEPT DONATION OF BURIAL SPACES AT SUNSET MEMORIAL GARDENS FROM EDITH L. LEBSACK, NOW KNOWN AS EDITH L. WILLIAMSON, AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, Edith L. Lebsack, now known as Edith L. Williamson, has donated two burial spaces located in Sunset Memorial Gardens to Weld County, Colorado, and WHEREAS, said spaces are more particularly described as: Garden of Good Shepherd, Lot No. 217, Section A, Spaces 1 and 2 in Sunset Memorial Gardens, Greeley, Colorado, and WHEREAS, the Board deems it appropriate and advisable to accept said donation. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the donation of the burial spaces described above and located in Sunset Memorial Gardens, Greeley, Colorado, by Edith L. Lebsack, now known as Edith L Williamson, be and hereby is, approved. The above and foregoing Resolution was, on motion duly made and seconded,adopted by the following vote on the 20th day of November, A.D., 2006. BOARD OF COUNTY COMMISSIONERS L'�/,� WELD COUN COLORADO ATTEST: ascp ;,as, ' ? .]M. e, Chair Weld County Clerk to th.^:o:r: �,,,� (`�� q ti .l4,, David E. Lon , Pro-Tem BY: ity Dep Cler o the Board' '7�l Jerke APPROVED AS TO FORM: , \ � Robert Masden C ty Att ne� U Glenn Vaad —. � Date of signature: Z (C 1 111111 11111 11111 11111 11111 1111111 1111111111111 IIII IIII 3443869 12/27/2006 02:09P Weld County, CO 1 of 10 R 0.00 D 0.00 Steve Moreno Clerk& Recorder 2006-3176 BC0036 (1(1; FZ EL_ Oi -//-6"'J SENT BY: TERAVATTON; 303 682 9632; OCT-24-06 12:22PM; PAGE 2/2 QUITCLAIM, RELEASE AND TRANSFER OF INTEREST IN CEMETERY INTERMENT RIGHTS AND/OR MERCHANDISE Ow KNOW ALL MEN ET THESE PRESENTS: THATUWE r.11 L. Ldjtnc k , nlL A E,L.a.5,, L. W;I licensor) RESw=AT a l e(,, -)5---4 _ I On • eCic3 l a. COUNTY OF k..1.e. 1 CAN STATE OF q ARE THE OWNER($ OF OR HAVE ANQT EQUITY 1NTER&CCofS 5( 7 1O, no INTHEFOLLOWING DESCRIBED CEMETERY INTERMENTRIOHTS AND/OR MERCHANDISE: _-TWO (ii? r4134- Garcia % n•C ClPYYi St.ep Nflf r LO-P e1 a_t &ct l aM a- _ FOR 11.00 AND OTHER vALUABLE CONSIDERATION.RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED.WE DO HEREBY QUITCLAIM.RELEASE AND TRANSFER ALL RIGHT,INTEREST;TITLE,USE.CLAIM,DEMAND,AND EQUITY,IF ANY,WHAT. SOEVER, IN THE ABOVE-DESCRIBED CEMETERY INTERMENT RIGHTS AND/OR MERCHANDISE AND IF APPLICABLE. AUTHORIZE ISSUANCE OF OWNERSHIP DOCUMENTATION TO: 5 itt S& �yr Lolcrri4o (R 0 C-3 n UN Its M a, — +x. AND BY TIM ACT.I/WE SE THE BELOW.NAMBD CEMETERY FROM ANY AND ALL LIABILITY OF ANY SW,............ NATURE WHATSO % - ,.C*NN +, rffl THIS TRANSACTION. - By, i- DIANE K. ? ; signed Ns 134-I day of .^e.-n:, r R.(--- B, Kali i ' •� SIGNATURE, Q�2_ U-(1.- -_ll K—\_ ``c.., . 0 O'SIONATURE; NAME OF C �''"• " ACCEPTED BY . .r,r.,,...., n.. SIGNATURE(S)OP YERSON(S)TO WHOM RIGHT.INTEREST,TITLE AND/OR EQUITY ARE WINO TRANSFERRED �ACKNOWLEDOED AND AOREED TO: I SIGNATURE: 3311 - - SIGNATURE SRO • 1IIIIII1111111111 IIIII 11111 1111111 IIIII III 11111 IIII IIII W121GI43r 35ra,6•LOCATION COPY �^N^ To900Z Sd 35 2006-3178 3443869 12/27/2006 02:09P Weld County, CO 2 of 10 R 0.00 D 0.00 Steve Moreno Clerk& Recorder THAT THE BEAUTY OF LIFE MAY SURVIVE Operators and Managers of: Suniet rc Company SUNSET MEMORIAL GARDENS, INC. o Route No. 3, Box 377, ROUTE 3. BOX 377 -c-a ROUTE 2 Greeley, Colorado 80631 GREELEY 80831 STERLING 80751 FAMILY SECURITY MEMORIAL, INC. A COLORADO CORPORATION Route No. 3, Box 377, PHONE 352-5590 5220931 Greeley, Colorado 8377, "� '`" � SUNSET MEMORY COM PAN V, INC. May 17 1967 Route No. 2, Sterling, Colorado 80751 FAMILY SECURITY MEMORIAL, INC. Route No. 2, Sterling, Colorado 80751 Mr . & Mrs . Harold D . Lebsack Rte . 1 , Box 14 Ault, Colorado Dear Mr . & Mrs . Lebsack: We are herewith enclosing the Deed for your Family Estate in Sunset Memorial Gardens . Your Deed number together with your Trust Fund money has been placed in care of our Trust Officer , Mr . Louis Rieker , at The First National Bank of Greeley. This will remain in their vaults and is subject to the examination of any interested person during banking hours . If there are any questions concerning how we can best serve our mutual interests , or if we can be of any service to you, please do not hesitate to call us or come in to see us . ncerel yfow�u�r.m�s g DeLoss Dhority ` --' Manager DD:mhh Enclosure 1111111 Ill Min VI111111111I1111111 Ill 1111IIII 3443869 12/27/2006 02:09P Weld County, CO 3 of 10 R 0.00 D 0.00 Steve Moreno Clerk& Recorder • The kiss of the Sun for pardon, The song of the birds for mirth; One's nearer God's, heart in a Garden, Than anywhere else on earth. —Dorothy Francis „;t t�°2�r a ₹xu ;xnrr.�li 1. 1t tm i t t i sxt rst }xwTs IL 1 IS r.nit y�r . .. r ₹₹Fi g .. i 3S1,a}₹� ';r,x h i<r L{ey -\ I 4. �-.e --e...-.- --. w..... -.E.ri. . . lri'j' �'1` llziti`—r.w.wi Y ' iive'iW ni .. Certificate of exchange 13ributegeg '� ' snobs It Jilen $p Zhese Presents: tirt That the undersigned is a member of Interment Exchange of America, Inc., a Missouri not-for-profit cor- Is poration, which has been organized to afford a reciprocal arrangement among members of such Exchange ) P 9 g $ whereby a purchaser of burial spaces, merchandise and services from a member in one location, who changes 4 ') his place of residence to a different location in which a cemetery is owned and operated by a member of the • 4' x : Exchange, may be given the privilege of procuring burial spaces, merchandise and services from the member r - j ' in such different location. 1 i i'° As a purchaser of burial spaces, merchandise and services from the undersigned, ( i ) i Mr, and Mrs . Harold D. Lebsack is entitled to such privileges of exchange upon full 1 x' j.a payment of the purchase price, subject to the terms, conditions and restrictions set forth in the membership s agreement of the Exchange, a copy of which is available for inspection in the office of the undersigned. s .A'.:(1I; These privileges are made available to the purchaser as an additional service to the extent permitted by , ,„ the reciprocal facilities of the Exchange and are not to be construed as a condition of the purchase of such /., burial spaces, merchandise and services. ,F Given this 17th lay of April 19 64 ' • (lathe'e Memar .�a igi , s .mber) • rill}f) '''m-)3.,2.) �'` r }"a v: ^r,-7 c ;r x xt l?'ji 'r r Li=:F> .: ₹ x roux °�t ix ell rc L x FF ' shis4 tifia�x " x r ' i r x ✓ 'r f, 1� :::4., -, .- '£l.. 's _.S.t -iu; -r i ' � . . ,�. ! . t :i 1F(scE xi . !at}< . tix F4 09P Weld Count', CO I IIIIII VIII VIII VIII VIII IIIIIII IIIIIIII VIII III IIII 3443869 12/27/2006 4 of 10 0.00 D 0.00 Steve Moreno Clerk& Recorder t Sunoet Memorial çarieno, inc. f _H //�qon-/p q yJ ro/I Corporation GREELEY, COLORADO j AGREEMENT THIS AGREEMENT made this__ ,--4/1 day of__— - , 19t7_, by and between { Sup¢¢t Memo i Garden Inc., p C lorado cof�oration, hereinafter called the "Company," and Z / � l M •>� g ,It-f�pG'. , hereinafter called the "Applicant." WITNESSETH THAT: The Applicant agrees to buy, and the Company agrees to sell in accordance with the terms h hereof, a burial estate in Sunset Memorial Gardens, located in Weld County, Colorado, containing 41 adult interment spaces. THE APPLICANT AGREES: eio (1) PAYMENT AND CARE FUND DEPOSIT: To pay the sum of $ 350 as the purchase price ( for said rights in said burial estate, and in addition thereto, to deposit with the Company $ 3 3 °IC' -(which deposit 4 equals not less than 10% of the above purchase price) which at the time of final payment upon the purchase price shall ,' IV be placed by the Company in the Perpetual Care and Maintenance Trust Fund heretofore(tr! esta lishecLgth THE FIRST NATIONAL BANK, Greeley, Colorado, the said purchase price, and deposit, totaling $ gS , to be paid "- as follows: OO p o t�' $ S at the date hereof, receipt of which is hereby acknowledged, and $__ .- �f — on I (t" the %' day of-7�, 7 • , 19 S j , and $ �— on the j/ day of l each succeeding /�' thereafter until the sum of $ 3 ?S' eg PLUS 50 CENTS PER PAYMENT shall have been paid. t I • (2) SELECTIPN OF BURIAL ESTATE: That a reservation will be allocated by the Company for a burial estate u containing LF adult spaces, in a semi-developed Garden that is now open to the Public Relations Department. Applicant may change the reservation any time within two years to any semi-developed Garden that has the same Public Relations cost, wherein not more than 33% of the spaces have been previously allocated by the Company. If estate previously selected is in a Garden under development and said estate is needed for inter- • �7 ment before it is ready for interment, Applicant agrees to transfer selection to a developed Garden. (3) COMPLIANCE WITH RULES: To at all times comply with all Rules and Regulations promulgated for the operation, care and control of said Sunset Memorial Gardens. I i THE COMPANY AGREES: (4) DESIGN AND CONSTRUCT GARDENS: That within two (2) years from the date hereof, if not previously �) done, it will design and construct a Garden, or Gardens, containing special landscaping, art and architectural features, 4i ' from which Applicant may select an estate as above provided. I (5) DEVELOPMENT: To expend for general improvements and development, including the building of Gardens, a sum equal to not less than 20% of the above purchase price. (6) CARE AND MAINTENANCE: To provide at its own operational expense, care and maintenance of the I roads, walks, fences, buildings, plantings, art`and architectural features, and the entire cemetery including the Care and Maintenance Trust Fund is sufficient I ! therefor.therem, until such time as the income from the Perpetual e (7) ISSUE DEED: To, upon receipt of the full purchase price, together with the care fund deposit and the selection by the Applicant, convey the right of interment in said estate by deed, free and clear of any and all f 'Pl encumbrances, tax obligations or future assessments, but subject to the Rules and Regulations heretofore or here- 0{ established for Sunset Memorial Gardens, Incorporated, a non-profit corporation. II V (8) IMMEDIATE USE: That the Applicant shall have the right to use said estate for interment at any time Oyj f. hereafter, 'provided the proportionate part of the purchase price applicable to that portion to be used and the care 141 `Qi fund deposit thereon, shall have first been paid. I. (9) PROTECTIVE PROVISIONS: In the event of unemployment of Applicant because of sickness, disability, h or other cause not the fault of Applicant, to suspend payments during the continuation of such unemployment for a period not exceeding one year, provided written notice of such unemployment, and the cause thereof, is given monthly to the Company, and provided all payments are current at the time such notice is received. If at the time of the execution of this agreement Applicant is in good health, and not over the age of sixty-five, should Applicant die after payment of not less than one-tenth of said purchase price, and if no payment is delin- I � quent at the time of death, and if Applicant is interred in said estate, all further payments will be waived. A deed (tr7 to said lot will then be given to Applicant's heirs without further payments. The benefits of this paragraph shall not apply cry' fffftttt� if Applicant dies during a period when payments are suspended due to unemployment, sickness, or disability, as set forth Rfl k V in the preceeding paragraph. In order to receive the benefits of the PROTECTIVE PROVISIONS, payments may not be Z i- more than thirty (30) days in arrears. M , IT IS MUTUALLY AGREED Rfl f (10) TRANSFER: That the Applicant shall have the right at any time, unless in default, to transfer his inter- [ est in said estate: however, such transfer must first be recorded upon the records of the Company before same be- 1� comes binding on the Company. {z11 I. V (11) DEFAULT: In case of default for more than sixty (60) days in any of the payments herein provided, i the Company may at its option declare this agreement null and void, and all payments made hereunder prior to default shall be retained as liquidated damages; or the Company may declare the entire balance due and payable I t�zf at once and proceed to collect the same by any and all lawful measures. In such event the Company may re-enter I f� and re-possess itself of the property, except as to any spaces wherein interment has heretofore been made. - (12) CONTAINS ALL COVENANTS: This agreement contains all of the covenants between the parties and no agent or representative of either party has authority to modify, add to or change any of the terms or conditions herein set forth, nor the terms or conditions of any receipt issued for payments. Applicant certifies that no oral or Owritten statements, promises, representations or guarantees, other than those contained herein have been made. V (13) AGREEMENT BINDING: This agreement shall become effective when duly signed by an authorized tom, ' nffirial of the flmm�anv and it. shall thereafter annly to and bind the heirs. executors, administrators, successors and [� 1111111 11111 111 VIII 11111 1111111 11111 111 11111 1111 III 3443869 12/27/2006 02.09P Weld County, CO 5 of 10 R 0.00 D 0.00 Steve Moreno Clerk& Recorder QUITCL RELEASEP-ANI) TRANSFER OF INTEREST IN - CEMETERY ` NT RIGHTS AND/OR MERCHANDISE NAY t‘ .,� 1 Date KNOW ALL MEN BY THESE PRESENTS: THATI/WE Harold D. Lebsack 'and Edith L. Lebsack • P. 0. Box 247 Pierce &0650 RESIDING AT 101 E. 20th Sit. . Spac _Co24 Greeley, Co 80631 Street City State Zip COUNTY OF W1A1d STATE'OF Colorado ARE THE OWNER(S)OF OR HAVE A MhNEi (NET)EQUIT INTEREST OF $ 192.50 IN THE FOLLOWING DESCRIBED CEMETERY INTERMENT RIGHTS AND/OR ME≥FIAN131SE:- Lot 217. Section Ar Spaces 1 & 2 S > Cn rr att of f'lhnr W1} nriha*n - rrkn}�{-L/{nom .rn c'LSZi11't interment:-apare3 ..: ; 1 FOR$1.00 AND OTHER VALUABLE CONSIDERATION,RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED,DO"f HEREBY .QUIT'CI,AIM,RELE 1SE.A IKA $.E RALL RIG, j?.INTEREST 1I ILEx,USE,,CL4IM,„DEIAAND,,ANt)EQUITY,IF ANY, WHATSOEVER, IN THE ABOVE DESCRIBED CEMETERY INTERMENT RIGHTS AND/OR MERCHANDISE AND, IF y. APPLICABLE,AUTHORIZE ISSUANCE OF OWNERSHIP DOCUMENTATION TO Edith L. Lebsack Edith L. Lebsack Name `Rdnt Name. 101 E. 20th St. space 24, Greeley, Co 80631 Address: Street .g„y State Zip Name. PtineName - . yaAddeess ...:... _ .. ,. . St at -..e..,.. .. ,.,...er .... _..,..... ,..QtX... ... ......, _._.,.�— ... .,..:.State...... ..: :. . ....CAP. AND BY THIS ACT DO HEREBY RELEASE THE BELOW NAMED CEMETERY FROM ANY.AND ALL LIABILITY,OF ANY NATURE WHATSOEVER IN CONNECTION WITH THIS TRANSACTION. Witnessed BY Signed this day of - 19 SIGNATURE: t 'ac �i' '� Notary Public ,D 41 e,t'e �� cS mr -2'), ' SIGNATURE: k /'its d• .J lit♦ c a�.� . Notary Public Clrt ck)kktf , NAME OF;. i Address ^4 SIte& .. City . State Zip ACCEPTED • rrYr/rdsir 7 i1 7_ C3 Authanied Representative Elite I SIGNA 4,SJ SON(S)TO WHOM RIGHT,INTEREST,TITLE AND/OR EQUITY ARE BEING TRANSFERRED ACKNOWLEDGED AND AGREED TO: Q SIGNATURE: ` 4I'.t. 111111 11111 11111 11111 11111 1111111 11111 III 11111 1111 1111 SIGNATURE: 3443869 12/27/2006 02:09P Weld County, CO 6 of 10 R 0.00 D 0.00 Steve Moreno Clerk & Recorder FORM C24 REV 6/89 COPYRIGITT 01989 SERVICE CORPORATION INTERNATIONAL. CUSTOMER COPY THAT THE BEAUTY OF LIFE MAY SURVIVE Memorial ✓✓✓arUJeno MANAGING DIRECTORS OF' Sunief ll � . SUNSET MEMORIAL GARDENS, INC. Route 2 Station, Colorado 80751 3400 28th Street FAMILY SKURITY MEMORIAL, INC. GREELEY, COLORADO 80639 Route 2 A COLORADO CORPORATION Sterling, Colorado 80751 GREELEY, PHONE 330-5590 STERLING, PHONE 522-0931 FAMILY SECURITY MEMORIAL. INC. ^. ..�.�.�.H.�,.`.p,�r`. 3400 28th Street Greeley, Colorado 80631 April 19 , 1990 ,, Mrs. Edith L. Lebsack 101 E. 20th St. SP #24 Greeley, CO 80631 Dear Mrs. Lebsack; We are herewith enclosing the Certificate of Interment Rights for your spaces in Sunset Memorial Gardens , which was trans- ferred from Harold D. and Edith L. Lebsack. Also enclosed is a copy of the Quitclaim release form. If you have any questions, or if we can be of any service to you, please do not hesitate to call us or come in to see us. Sincerely yours, Sunset Memorial Gardens , Inc . Mildred Feit Assistant Secretary encl. The kiss of the Ann for pardon, mb The song of the birds for mirth; Ones nearer God's heart in a Garden, Than anywhere else on earth. —Dorothy Francis III VIII VIII IIIIIIIVIIIIIIVIII IIII IIII I II (IIII Le° U 0 00:09 ve Weld C o Cie oi rk&Recorder 7 of ".p^ ePgFA.�..F yFFFAPAy n gP�a ¢ r`.P P S P P•ig4 9n anlc SUNSET MEMORIAL GARDENS 's it 3400 28th Street • Greeley,CO 80634 • (303) 330-5590 "S CERTIFICATE OF INTERMENT RIGHTS " COUNTY OF: Weld N2 400585 KNOW ALL MEN BY THESE PRESENTS: Sa,1 That the undersigned,the Grantor,a corporation,fully qualified and authorized to transact business in the above referenced state,in consideration of the purchase price to it in hand,paid receipt of which is hereby acknowledged,does hereby grant and convey unto Edith L. Lebsack 101 E. 20th Street, Space #24 , Greeley, CO 80631 as Grantee, for sepulcher purposes only, subject to the conditions, reservations, restrictions and rules and regulations set forth ' / herein,the following property situated in the above named facility, county, and state described as Garden Of Good Shepherd, Lot 217 , Section A, Spaces 1 & 2 according to a map of the said facility filed in the office of the County Recorder of said county and state. :,, • That this conveyance,and all right,title and interest hereby conveyed in the property above described,is subject to all laws and ordinances,and to the following conditions,reservations,restrictions and rules and regulations, and the -s,, Grantee covenants and agrees that: j (a) No transfer,conveyance or assignment of any interest or rights acquired by Grantee shall be valid without the written consent of Grantor and being thereafter recorded on its books. (b) No inscription, alteration or ornamentation, no monument or other memorial, tree, plants, objects or embellishments of any kind shall be placed upon,altered or removed from the above-described property by the Grantee F 1 without the written consent of Grantor.All grading,landscape work and improvements of any kind,and all care on the above-described property,shall be done,and all trees and plants of any kind shall be planted,trimmed or removed,and all interments,disinterments and removals,including all openings and closing of graves,shall be made only by Grantor • with its equipment. All interments shall be made subject to the use of the type of an outer container as shall be designated by Grantor in its rules and regulations. • (c) Grantor,at the expense of Grantee and as a charge against the above-described property,may repair or remove . ' any monument or other memorial which is improper or offensive or which has become dangerous or dilapidated;and a may remove any tree, flower or plant,or other object or embellishment that becomes unsightly or dangerous. (d) Grantor shall not be liable for loss or damage caused by an act of God,common enemy,thieves,vandals,strikers, malicious mischief makers,unavoidable accidents,riot or order of any military or civil authority. (e) The enumeration herein of certain conditions, reservations, restrictions and rules and regulations shall not be considered as the only limitations,but the Grantee shall always hold all his interest and rights limited by and subject to the rules and regulations and by-laws of Grantor now existing or which may be by it hereafter adopted either by amendment,alteration or the adoption of new ones.These rules and regulations are on file for inspection in Grantor's office and are specifically referred to and herein incorporated as if set forth in full. (f) The Grantor agrees to provide endowment care as defined in its regulations,without further charge. (g) In the event this certificate is issued prior to the time the within described interment property has been • developed and is ready for interment, the Grantor may, with the consent of Purchaser, and at no increase in price, xi permanently transfer Purchaser's right to a reasonably comparable developed interment property, or to temporarily -. transfer such rights to a reasonably comparable interment property, until such time construction is completed. It is further agreed that Seller retains the right and authority of interment and disinterment and there shall be no additional cost to the Purchaser for this service when performed at Seller's request. All the above conditions, reservations, restrictions and rules and regulations are binding upon Grantee, his heirs, ', devisees, executors, administrators and assigns, and are enforceable only by Grantor or its successors in interest. , .. 3g Nothing herein contained shall be deemed to restrict the use of any other portion of the cemetery than that herein x conveyed to Grantee. , a- IN WITNESS9 HEREOF,the said fa ty has caused thesenprresents to be executed in its name by its duly authorized officers this day of April , l9 y • -a . SUNSET MEMORIAL GARDENS, INC. , 23. . dba SUNSET MEMORIAL GARDENS Rta'De, (4iferd ♦�; By: President < s 1 111111 11111 11111 11111 11111 1111111 11111 111 111111111 IIII 3443869 12/27/2006 02:09P Weld County, CO 8 of 10 R 0.00 D 0.00 Steve Moreno Clerk& Recorder y ` 0Z 1 N S Z N Z sl 0 W I 0 _ �i Q o \\`{ V Cr 8- x b l9 a ` I O • g 0 b ..r ❑o 0 4 \I, ` 0 .a Q K O 1-1 O 0 h — w IVialla / an \\ W W +a W :. w ~ M �\ N W N (� �� _$ W W ��[ W Pi I—I17V N W m ei ,g \�� '� 3 } 2 u o- A \\\\\. 1.4 id y 'ti ' \\I 1 F W g w L. I 4 \ Ma`: f 4 \ jifNUA� NJ d/ u \\\\\\\ 1 o \ k cu r\N\\\\\\�\�\ `-° minivan y Ht// \\\ \ • . � *- �nil Q e ClAN7�� \ 70N.7Ay Htg \ 7NK7A7//,� . \ � .........n,,,... NNI la pOQor D !701 4 0 D 1 _______„.....4 •i 1 .... ... •Q t `. O O © .r Al -4 so 0 Oi "; ';* . a A — 2. is cc v1ip .. , e r as ma ea oO A. y pp y �3d ro"11 pc, O O c ` `, X •00 SO C a 1 r, o� - r' a p - 6 a —Np raS 1- 8S % N OC ca a o d ! c°Si 2 I i ego E W i ,. ��Z. f. 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LUCY WILLIAMSON of 830 1s` STREET, SPACE 41, PIERCE, WELD COUNTY, COLORADO 80650, do hereby execute this General Power of Attorney with the intention that my agent hereinafter named shall be able to act in my place in all matters. SECTION 1.00 - DESIGNATION OF ATTORNEY 1.01 I constitute and appoint CELIA L. KIRKPATRICK, my DAUGHTER, to be my attorney- in-fact or agent ("agent"), to act for me, in my name and place. If my daughter shall cease to act as my agent because of death, incapacity or resignation, then I appoint as my successor agent, my SON, H. DAVID LEBSACK. SECTION 2.00 - EFFECTIVE DATE OF POWER OF ATTORNEY 2.01 This General Power of Attorney shall be effective upon my incapacity or disability, and shall not be effective until then. This Power of Attorney shall not be affected by my incapacity or disability, it being my specific intention that my agent shall act, upon my incapacity or disability, even though I may not be competent to ratify the actions of my agent 2.02 In lieu of a judicial determination of my incapacity or disability, I shall be presumed to be incapacitated or disabled (and this General Power of Attorney shall become effective) upon presentation of a notarized statement to that effect from my regular physician, or two other physicians selected by my agent. 2.03 Any person, organization, or entity to whom a statement referred to in Section 2.02 is presented may rely upon such statement as evidencing my continuing disability. Third parties may rely upon the representations of my agent as to all matters relating to any power granted to my agent, and no person who may act in reliance upon the representations of my agent shall incur any liability to me or to my estate as a result of permitting my agent to exercise any power 2.04 This power is revocable, provided that insofar as any governmental agency, bank, trust company,insurance company,other corporation,or other person is concerned,who shall rely upon this power, this power may be revoked only by a notice in writing executed by me or by my agent and delivered to such person or institution. 2.05 This power of attorney shall not be revoked or otherwise become ineffective in any way by the mere passage of time, but rather, shall remain in full force and effective until revoked by me or my agent in writing, as provided in Section 2.04 hereof. x t 1., SECTION 3.00 POWERS 3.01 My agent may do everything necessary in my name or for my benefit which I could do if I were personally present and able. It is my intention that my agent may perform any act and exercise any power, duty, right, or obligation that I could perform or exercise. Such authority is intended to relate to any person, transaction, or interest concerning real and personal property, including intangible property interests, in which I now have an interest, and property in which my interest is subsequently acquired. I empower my agent to delegate authority to others. In addition thereto, and not in limitation thereof, my agent shall also have the powers set forth below. 3.02 My agent may collect and receive, with or without the institution of suit or other legal process,all debts, monies,gifts,objects, interest, dividends,annuities,and demands that now are due, or may hereafter become due, owing or otherwise payable or belonging to me. My agent may use and take all lawful actions in my name or otherwise to recover the same and to compromise the same. 3.03 My agent may sell, convey, lease, exchange, mortgage, pledge, release, or otherwise deal with, dispose of, or encumber any of my property, either real or personal. This shall include the power to borrow money or otherwise obtain credit upon such terms, condition, and covenants as my agent considers to be appropriate. 3.04 My agent may appear on my behalf in any litigation in which I am, or may become, a party during duration of this General Power of Attorney. 3.05 My agent may give discharges, releases, consents, and receipts on my behalf. 3.06 My agent shall have the power to deposit funds in my name in any banking or savings institution, or in any "money market" account, whether or not insured. 3.07 My agent shall have the power to pay any and all bills, accounts, claims, and demands now due by me or becoming due by me subsequent to the execution of this General Power of Attorney. In connection therewith, my agent may withdraw funds from and draw and sign checks in my name upon any bank or trust company, savings institution, or money market fund in which I may have funds on deposit 3.08 My agent may endorse all checks drawn to my order for deposit in any account in which I have funds on deposit or in any new account opened in my name. 3.09 My agent shall have the power to hold, invest, reinvest, and otherwise deal with and manage all property in which I have any interest 2 3.10 My agent shall have the power to transfer or surrender any securities which I may own. In connection therewith, my agent may execute in my name or on my behalf any stock power or other instrument in order to effect any such transfer or surrender. 3.11 My agent shall have the power to enter into or renew any agency or custodian agreement with any bank or trust company at my expense for the investment or safekeeping of any property. This shall include the power to revoke any agency or custodian agreement, whether the agreement is entered into by me, by my agent, or by any other person. 3.12 My agent shall have unrestricted access to, and the right to, enter into any safe deposit box, vault, storage warehouse, or other depository which I may own that may be registered in my name or in which any property may be held for me. 3.13 My agent shall have the power to prepare, make, execute, and file any and all federal, state, local, or other tax returns, claims for refunds, or declarations of estimated tax, requests for extension of time, petitions regarding tax matters, and any other tax-related documents, including offers, waivers, consents, agreements and any power of attorney required by any taxing authority. This power shall include the power to represent me (directly or through attorneys, accountants, or other agents) in any matter before the Internal Revenue Service, or any other federal, state, or local agency. In connection with such representation, my agent may execute consents extending the statutory period for the assessment or collection of taxes, may pay all taxes and interest thereon which I may properly owe or which may be assessed against me, and may contest the validity of any proposed assessment, exercise any election available to me under federal, state or local tax law, and act for me in all tax matters for all periods before the Internal Revenue Service and any other taxing authority. 3.14 My agent shall have the power to execute, seal, acknowledge, and deliver any instruments, documents, or papers deemed necessary or advisable with respect to any of my property. 3.15 My agent shall have the power to apply for a Certificate of Title upon, and endorse and transfer title thereto, for any automobile, truck, pickup, van, motorcycle, or other motor vehicle in which I have an interest. 3.16 My agent shall have the power with respect to insurance and annuity transactions to procure, continue, modify, change, convert, sell, assign or terminate any contract of insurance or annuity which insures me or provides an annuity to me or another person. 3.17 My agent shall have the power with respect to estate, trust or other beneficiary transactions to act for me in all such matters to accept, reject, disclaim, receive, assign or exchange any share or interest I claim or be entitled to as a beneficiary. 3 'an 3.18 My agent shall have the power with respect to benefits from social security, Medicare, Medicaid or any other governmental program, or civil or military service, to act for me to file and prosecute a claim for me to any benefits under such programs, and to accept, settle, or compromise any claims for me with respect to any benefits. 3.19 I grant to my agent full authority to make decisions for me regarding my health care. My agent may act on my behalf when I no longer have the ability to provide informed consent to or refusal of medical treatment. In exercising this authority, my agent shall follow my desires as stated in this document or otherwise known to my agent. In making any decision, my agent shall attempt to discuss the proposed decision with me to determine my desires, if I am able to communicate in any way. If my agent cannot determine the choice I would want made, then my agent shall make a choice for me based upon what my agent believes I would have chosen. My agent may not consent to or refuse any proposed medical treatment for me over my objection when I have the capacity to decide myself. My agent's authority to make decisions about my medical treatment shall be as broad as possible. My agent shall have full authority to make decisions about the giving, withholding, or withdrawal of any health care or medical procedure, including artificially provided nourishment or hydration; surgery; cardiopulmonary resuscitation; or service to maintain, diagnose, treat, or provide for my physical or mental health or personal care. My agent shall also have the authority to arrange, contract for, and consent to on my behalf my admission to a hospital, nursing home, or other health or residential care facility. My agent shall have the power to act on my behalf in consenting to or refusing medical treatment as defined in the Colorado Patient Autonomy Act (Colorado revised Statute Section 15-14-503 through 509), with full powers to the maximum extent permitted in the Act. All other medical provisions of the Act are incorporated into this power. SECTION 4.00 - RATIFICATION, USE OF PHOTOCOPY, REVOCATION OF PRIOR POWERS, AND CONSTRUCTION. 4.01 I hereby ratify and hold valid all acts taken by my agent pursuant to this power. 4.02 I hereby authorize the use of photocopy of this General Power of Attorney, in lieu of the original copy executed by me, for the purpose of effectuating the terms and provisions hereof. 4.03 I hereby revoke all General and Limited Powers of Attorney previously executed by me, if any, and the same shall be of no further force or effect. 4.04 This General Power of Attorney is executed and delivered in the State of Colorado, and the laws of the State of Colorado shall govern all questions as to the validity of this power and as to the construction of its provisions. 4 r P9 ) 4.05 This instrument is to be construed and interpreted as a general durable power of attorney. The enumeration of specific powers herein is not intended to, nor does it, limit or restrict the general powers herein granted to my agent. 4.06 My agent shall have the obligation to keep full and accurate record of all transactions handled on my behalf by use of this power of attorney, and to account to me or my designated agents upon my or their demand. IN WITNESS WHEREOF, I have executed this General Power of Attorney this -I D day of JULY, 20 02 . a"► k i . G✓�U EDITH L. WILLIAMSON a.k.a. LUCY WILLIAMSON STATE OF COLORADO ) ss. COUNTY OF WELD The foregoing instrument was acknowledged before me this a30 day of JULY. 20O2 by EDITH L. WILLIAMSON a.k.a. LUCY WILLIAMSON. WITNESS my hand and official seal. Pu ee 1� g i�� •....... ... . lid, 4� • ti PETE D.ARCHULETA Notary Public l� " y' My commission expires JAY COMMISSION ILAR dl s: 3 ii-L„Un ACCEPTANCE BY AGENTS: I agree to serve as the agent under the delegation of authority set out in this General Power of Attorney. I also accept the responsibilities and obligations of this appointment. AGENT'S SPECIMEN SIGNATURE DATE AGENT'S SPECIMEN SIGNATURE DATE 5 FAMILY PHYSICIANS OF GREELEY A Professional LLP WEST CENTRAL 117558th Avenue, Suite 100 2520 W. 16th Street Greeley, CO 80634 Greeley, CO 80634 COTTONWOOD (970)378-8000 (970)356-2520 2420 W. 16th Street Fax(970)378-8088 Fax:(970)356-6928 Greeley, CO 80634 Ann T.Colgan,M.D. Joanna H. Branum,M.D. (970)353-7668 R.Scott Haskins,M.D. Daniel R. Clang, D.O. Fax:(970)353-2801 Matthew L.Martinez,M.D. Tamara S. Clang, D.O. Stacey L.Garber,M.D. Kenneth M.Olds,M.D. Douglas A.Magnuson,M.D. Dana L.Greene,M.D. Michelle K.Paczosa,D.O. Lori A.Ripley,M.D. Christopher T. Kennedy,M.D. Jeffrey E.Peterson,M.D. D. Craig Wilson,M.D. Daniel P.Pflieger,M.D. Kelly W.Tucker,M.D. Charles 1.Zucker,M.D. Mark D. Young, M.D. I.David Ward II,M.D. October 26, 2006 RE: Edith Lucille Williamson DOB: 6-29-23 To Whom It May Concern: The patient is a 73-year-old female who has had multiple CVAs. Due to multiple medical problems she is unable to care for herself, sign checks, and take control of her personal matters. If you have further questions regarding this, please feel free to contact me. Sworrktp before me and subscribed in my presence this qTh day of I.QVQ1fLbe( , 2006. ":► , : Patuacullotbatua *Commission � ;• '.9 Notary Public Art I,Nil �ARY PUBLSc' +8 ...... :. of Sine' - , Craig Wilson, M.D./rjm CW/rjm AR2249460 day B 1298 REC 02249460 05/Q7/91 16: 30 X0. 00 1/001 _ _ ____ 3ook No _ F 0684 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO tl THIS LICENSE VALID FOR ONLY 30 DAYS FROM DATE OF ISSUE. l4 NOTE: THIS IS A MARRIAGE LICENSE-NOT A MARRIAGE CERTIFICATE. IF IT IS NOT USED. THE PERSON TO WHOM IT IS DELIVERED MUST RETURN IT PROMPTLY TO THE COUNTY CLERK AND RECORDER WHO ISSUED IT. C' Ij , ,e . l rra —�� N° 59148 ` ' 11* RAU OF COLORADO. ;.----- COUNTY OF WELD - , GREETING: Saiseyor zct or. zky iiniiih arn lagez Air HOWARD WELLS WILLIAMSON AULT COLORADO ,and' tAl EDITH LUCILLE LERSACK AULT COLORADO Vat �r a/ (laIli.eat67 Imo` Greeley*olorado.,%( O' 2nd x1/2,43/9 "" z MAY 9,51 91 ''; NSF MARY ANN FEUERSTEIN ry,"� r, c�c_,,IJ j� a___6E' �9l aG10:10aa/ce+� A .� ,..%, ( D � 04 STATE OF COLORADO, s. sa. •4 County of ,AvAiei co e44, Q i�.�/j21n�!��75U�� /a- 4 ./p /Q o , ,. .�/�/ati7�/j9/�//!?� /000.J/.6L1�� i00.�'�G�YI'///YLO�'L/y/avyac °-t %CP/iL'UGL�/�2P/. r o-41.97A/al9,6,Wo4m a atz,a Oti7r �a% n/oaeeifoir ego Areeerei/tti Ain .--_,(k/l Gc 1 4mrr Al ,4I! , C0 /and it b�/, L., /' /e/" <I lei1. e46 m ,tianialAga t a!a,erzni/r,�.v�,eziove rrrd Official rid • Signed �j( ,,,,,JJ...... E�f/�'j'I ,�� '�/t Groom "" ��-4 t at Signed (� d zL.,..'� !'(4,A Ll-orC? Witness Bride C. Return to P 0 ROY 1911 An t t Co 80610 This Certificate, duly executed together with the License, must be returned by the minister or officer who shall have solemnized the marriage, to the office of the County Clerk who issued the same, promptly. Penalty provided by law for failure to do so. F.R.S.:0 "En"ES °IN.ER Hello