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HomeMy WebLinkAboutAPPLICATION & DOCS - 06-00401 - Ora Green - 839 W Main - Annexation & Rezone to CBC~ ~~cE~~® P~URG~O~ o G ~ ~ LOO 12 North P.O. Box 280 ~Q (L Q~/ ~ ~~ QQ Jy°~J Center Street ~ `. _ ~ ~/ CITY OF4~EXBURG R~Er(2oe) 353so2~o ~`r~,q ~^~~ STATE OF IDAHO Fwc (208) 359-3022 eGISHE~ e-aw~ c• hell ity @ci.rexburg.id.us Annexation/Rezone Application Note: Apre-application conference with staff and apre-application neighborhood meeting are required prior to the submittal of this application. Contact City Hall at 359-3020 for details. File Number: Current Zone: N`~' Requested Zone: ~~,~,~ ~,,,~~ ~i' Applicant Information Fee: Cross Reference File: vs' Applicant: (~k',/-{ ~~~~-ti7 ~ Owner ^ Purchaser ^ Lessee Applicant's Address: ~ ~ 9 C-~ , r711 c< ~ ~, Recorded Owner. ~,~. ~a~EN Recorded Owner Address: ~ ~ ~j (..~, ~ 4 Contact Person (If different from above). r „-g. ,~.~,,q Address of Subject Property: ~, ~ ~ ~ ~ , Phone:. 7~i g .~ ~ 3~S"fi= $ ~'~ ~a < <'.~, Property Description (You must attach the Lot, Block & Subdivision name or recorded deed with a metes and bounds description): Parcel Number: Quarter:N~-- ~=s Section: ~ S Township: ~_ Range: N~~--f~ ~~ ti f Mapping Department must initial here to signify parcel verification; Last Modified: 1/23/2004 4:44 PM Internal Office Routing Planning and Zoning Coordinator Review Public Works Department Legal Services Office (Category A, B, or C) Mayor Administrative Review (Appropriate Fees Paid) Annexation Fee: $250.00 Publication Fee: $250.00 Total Fees Due $ ~~~~~ Rezone Fees: (less than 1 acre) $500; (more than 1 acre, less than 5) $850; (S to 10 acres) $900; (over 10 acres but less than 20 acres) $1,500; (20 acres and over) $2,500; Zoning Verification Letter (Financial Institutions) $25; Date of Notice: Date of Public Hearing: Reviewed (Annexation Plan) (Can services be provided) (Comprehensive Plan Compliant) (Approval to proceed) AUG 1 ~ ~~~6 Phone: Annexation: $500.00 Rezone: $ '~50•ub Zip: ~ t~ y ~iL~ Phone: ~.S ~ ~L~y~ FAX: ~ ~ Development Information 1. Size of Property Square Feet (or) ~~ o ~~ Acres 2. How is the property now used? ~~ S tch-.e 3. How are the adLoining properties,,,used? North: Ca-~t~y~µe~ y __ South: ~ ~.«c cr ~,~ ~ East: //~.~~~`~.~ :~ West: (~' ` n r .v ~- v ~^ i e-~ 4. Are there any existing land uses in the general area similar to the proposed use? If yes, what are they, and where are they located? - ./ ,, /~ f'e~ • •~ - ~ ~ r'e.~ .-~.d 5. On what street(s) does the property have frontage? f`'6 d~t~ eye ~ ~~ 6. Why are you requestin annexa on into the City gf Rexburg? ~'Gl/C>r.~.y Gip rE~ ~ ~,~,s ~ „~ ~~~~ 7. What use, building or structure is intended for the property? /~-~d~lt i~,. ~s ~ 7~ "~.~s '~ ,,,~.~ r $. Will this annexation have an impact on the schools? ICS C~ 9. Are wat-ery~tld sew facilities, streets, fire and Police presently serving this area? YG1 -- ~ % ets~ 10. Are City services adequate to serve any future development proposed? 1r-~ 11. Will measures be proposed to assure that public facilities and services will be added? /y//~ 12. Is the site large enough to,(~a~ccommordate the proposed uses, parking, and buffering required? N~~ ~ T wfi .iR . . 13. Is the area currently sub-divided or going to be sub-divided? _ 14. Any additional comments? ~ rS l S ~ +~t Cy c~ Jd u Ht~ t e. ~ .~ •~-~~ Note: When an application has been submitted, it will be reviewed in order to determine compliance with application requirements. It will not be processed if it is not complete. A hearing date will be scheduled only after an application has been accepted as complete. 1. A formal traffic study will be required for a retail sales area more than 75,000 feet; Schools for more than 100 students; Apartment complex with 50 apartments or more. 2. Before annexation, the person or firm applying for annexation will agree to certain things: Curb and gutter, streets, signaling,pw~ate"r and sewer, property sizing and location. Signature of Applicant: C~ t3~„ ~~ ~C t, •, w Date: ~L~ 2 Additional Submittal Requirements: The City of Rexburg requires the following information to be submitted to the City Clerk for every application for annexation: 1. Current Vicinity Map. (8 '/z x 11 ") at 1 " = 300' scale, showing location and current zoning of the property. Map is available from the City Planning and Zoning Office. Please indicate the location of your property on the map. 2. Land Description. Attach a description of the actual property which you wish to have rezoned or annexed on a separate page. All land descriptions must be certified by a land surveyor registered in the State of Idaho, A. Description shall mathematically close. B. Descriptions shall be provided for the perimeter of the total area for which annexation is being requested; and for each zone (separate zoning classification) within said request. All zone descriptions shall correspond to the perimeter description. Descriptions shall identify a basis of bearing based upon two (2) known points from which the descriptions are based. C. Descriptions provided may be required to be modified by the applicant to include adjacent roads, canals, ditches, rivers, creeks, etc. as may be identified by the Public Works Department. 3. Photographs. Photos of existing site conditions. 4. Affidavit of Legal Interest. NOTE: No application will be accepted or processed without this form. C~ Affidavit of Legal Interest City of Rexburg 12 North Center Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022 OF pEXBUgC ~; ~~ U.~ 70 CITY O F REXBURG America's Family Community State of Idaho County of Madison Name ~~ ~~~~ city , Address ~~ State Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) A. That I am the record owner of the property described on the attached, and I grant my permission tos IV of %c ~ N ~/ ;,300 ~ l~C'S-~y ,~ ~3yy, Name Address ~ to submit the accompanying application pertaining to that property. B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability resulting from any dispute as to the statements contained herin or as to the ownership of``the property which is the subject of tThe application. Dated this ~ ~t~ ~ day of !1 ~ ~ ~ 20~_ Signature Subscribed and sworn to before me the day and year first above written. 't;'''~ ... ^ `'+~ ~ Notary Public of I o t;.~ ~"t~Y ~~ `. ~ Residing at: 1`~' U~ (~,1 ~ ~~ C~ fl l -~ i ~~~ i My commission expires: ~ ~ ~ ~ 1 ..ASE O~ ~~ 4 • Process of Annexation Properties subject to annexation must be contiguous or adjacent to City limits, with the exception of an airport. The process of an annexation application is as follows: 1. Apre-annexation hearing before the City Council: a. Owner should submit a letter requesting apre-annexation hearing before the City Council. The letter must state the property owners name and address, request for annexation and land use intent, and proposed zoning; b. The property owner or representative must attend the Council meeting. 2. Application must include: a. A legal description of the property which plainly and clearly defines the boundary of a new district or municipality describes, by metes and bounds, a definite boundary of an area of land that can be mapped on a tax code area map. The legal description shall include: i. Section, Township, Range and Meridian ii. An initial point, being a government surveyed corner, such as a section corner, quarter corner, meander corner, or mineral survey corner; iii. A true point of beginning defined by bearings and distances from the initial point, that begins the new or altered district or municipal boundary; iv. Bearings and distances that continuously define an area boundary with a closure accuracy of at least 1 part in 5,000. Variations from closure requirements of this subsection may be approved when boundaries follow mountain ranges, rivers, lakes, canals, etc. v. The legal description shall include all portions of highways lying wholly or partially within the annexed area. b. Proof of ownership of land c. A draft-like drawing of the layout of property, or a record of survey, as defined by IC< Title 55, Chapter 19, which matches the legal description. d. All property owners' names and addresses within a radius of 300 ft. of the property. e. Fees must accompany application. NOTE: Upon acceptance of the application, the developer/owner shall post the property described in the application no later than one week prior to all public hearings before Planning and Zoning and City Council. s • PREPARATION OF ANNEXATION All required information is received and accepted by the City Clerk or appropriate staff. 2. After pre-annexation hearing a public hearing is set before the Planning and Zoning Commission as provided for in IC 67-6509; Transmittals sent to proper entities (power, water, sewer, highway districts, etc.) 4. Property owners within a radius of 300 ft. of the boundaries of the proposed annexable property noticed. If there are 200 or more property owners alternate forms of procedures will provide adequate notice and may be used in lieu of mailed notice. (IC 67-6512); 5. Letter is sent to applicant advising them of the time and date of the hearing; 6. Planning and Zoning public hearing takes place and findings of the hearing are prepared; 7. After the acceptance of the findings by Planning and Zoning, Council public hearing date is set and published; 8. Following the Council hearing, the Council shall concurrently or immediately amend the Comprehensive Plan and Zoning Ordinance (IC 67-2525); 9. UPON PASSAGE OF ANNEXATION AND ZONING BY COUNCIL: A. Certified copies of the ordinance shall be filed with the County Assessor, County Treasurer, and State Tax Commission. The County Recorder must receive the original (certified) for recording no later than 10 days following the effective date of annexation (50-223) B. Certified copies must include the executed ordinance, a legal description, and a map. C. A summary of the annexation and zoning ordinance is published in the official newspaper of the city; D. Three copies of the ordinance retained on file in City Hall. 10. The City boundary map is changed to reflect the annexation and zoning. 11. A formal Annexation Agreement will be developed between the City of Rexburg and the Developer prior to Annexation. • ~ QUIT CLAIM DEED The GRANTOR, Ora Hymas Green trustee for Green Family Trust for and in consideration of $ 0.00 ( & no/100 dollars) in hand paid, conveys and quit claims to Green Family Trust dated 6/24/91, GRANTEE, the right, title and interest, if any, which GRANTOR may have in the following described real estate: In the State of Idaho,Madison County. Beginning at the Northwest corner of Northeast Quarter (1/4)of section Twenty Five (25) Township Six (6) North Range Thirty nine (39) East. Thence South 393 feet. This is the true point of beginning. Thence South 2-67 feet, Thence East 330-fee-t-, Thence North 267 feet „ Thence West 330 feet back to the true point of beginning. Location of above described property is south of 839 W. Main Street Rexburg,Idaho (formally known as 1494 West Main Street, Rexburg,Idaho). Reserving a life estate for Ora Hymas Green. Dated this 0 (~ day of ~~l<<y~'~, 2004 Ora Hymas Green / STATE 0~~~~° COUNTY OF ~'/;~~s' "~~ ~~ On this day of ~L~IG=~G~I 2004 before me the undersigned personally appeared, before me Ora Hymas Green, known or identified to me ( or proved to me on the oath of), to be the person(s) whose name subscribed to the within insturment acknowledged to me that she executed the same as such Trustee. I~ Given under my hand and official seal on this , ` ` \C. +(` ~ 2004 ~ O ~~ Notary Public of \ ., ~% Residing at ••~'• My Commission Expires:_ ~ .tA •Yb _~~_4 ~S bl O N ` Instrument # 310737 REXBURG, MADISON, IDAHO 2004-03-17 09:23:00 No. f Pa s: 1 Recorded for : ORA GREEN Fee: 3.00 MARILYN R. RASMUSSEN Ex-Officio Recorder Depu ~~ S • v~' r 0 -~ {~ ~. ~ m:... `... ~: `, t r'°' Q p+C t°s r v~ - ~ ~O ~ E ~ ~ ~ ._ _. . ~ _. ~ _ _ _... _.-_ s - - `.::,. __.__~ , i ;- -. ly N ~ ~ ~ - ! --: ~ ,..E ~, o ~ ,. f A F ~_ ~ ~l Nom' •~ ! i y _ -- .-~_~_~. ~ I I IvCW4.Q/~N ` 3 _ ~~~/ N \ ..... ~dC4.(i(a. Tr ~......_._.~........~.. aSOS 9 ~-'s of '~ ~ W ~~N O ~ W ~ N Cis C:Y ~t .~ L ~ ~ J .~, z ~- Cot:c~- vy O ~; G J t ~ J'~f ~.~ fat ~',' W p S .N ~ ~. .^i~ . `~ ,5~ 1-" Nw it ~~ i! . ~ -.. W N ~ w _p .__._,...,__ ~ ~:: d ...._.._.____. £; 9 _. ._._~.l4«.. - .N ~ J -~ Q n _ r fy~~ ~ ~ ~~ ~` e L ,_ i _. ORDINANCE NO. 973 AN ORDINANCE ANNEXING CERTAIN LANDS TO THE CITY OF REXBURG, IDAHO; DESCRIBING SAID LANDS AND DECLARING SAME A PART OF THE CITY OF REXBURG, IDAHO; AND AMENDING AND CHANGING THE ZONING MAP OF THE CITY OF REXBURG, IDAHO, AND THE CLASSIFICATION OF THE SAME UNDER THE ZONING ORDINANCE OF THE CITY OF REXBURG, IDAHO; AND PROVIDING WHEN THIS ORDINANCE SHALL BECOME EFFECTIVE. WHEREAS, the lands hereinafter described are contiguous and adjacent to the City of Rexburg, Idaho, and have been laid off, subdivided or platted, and/or the City has been requested to annex the same to the City of Rexburg, Idaho, and WHEREAS, it appears to the Mayor and City Council of the City of Rexburg, Idaho, that the hereinafter described properties are subject to annexation to the City of Rexburg under and pursuant to the provisions of Section 50-222, Idaho Code, and that said lands should be annexed to and become a part of the City of Rexburg, Idaho, and WHEREAS, the City Council referred the zoning of the affected territory for report and recommendations to the Planning and Zoning Commission, and the Planning and Zoning Commission made its report and recommendations for zoning classification of the hereinafter described properties proposed to be annexed, and WHEREAS, the Council has determined that the proper classification under the Zoning Ordinance of the City of Rexburg, Idaho, for the properties to be annexed are as hereinafter set forth. NOW, THEREFORE, BE IT ORDAINED BY THE MAYOR AND CITY COUNCIL OF THE CITY OF REXBURG, AS FOLLOWS: SECTION I. "That the following described lands situated in Madison County, Idaho, to-wit: Parcel No. 1 Beginning at the Northwest corner of Northeast Quarter (NE'/4) of section Twenty Five (25) '1"ownship Six (6) North Range Thirty nine (39) East, Boise Meridian, Madison County, Idaho; thence south 393 feet. This is the true point of beginning; thence south 267 feet; thence east 330 feet; thence north 267 feet; thence west 330 feet back to the true point of beginning. The zone change for Parcel No. 1 (one) is from Kural Residential 1 (RR1) to Community Business Center (CBC). Parcel No. 2 Beginning at the Northwest corner of Northeast Quarter (NE'/a) of section Twenty Five (25) Township Six (6) North Range Thirty nine (39) East, Boise Meridian, Madison County, Idaho; thence south 393 feet; thence east 95 feet; thence north 393 feet; thence west 95 feet back to the true point of beginning. The zoning for Parcel No. 2 (two) is (RR1) Rural Residential 1. Instrument # 331971 REXBURG, MADISON, IDAHO 2006-10-17 04:49:00 No. of Page : 3 Recorded for :CITY OF REXBURG ORDINANCE NO. 973 -1- MARILYN R. RASMUSSE Fee: 0.00 Ex-Officio Recorder Depu L~ October 18, 2006 State Tax Commission Attn: Jeff Servatius 800 Park Blvd. Plaza IV Boise, Idaho 83722 Dear Jeff, ~~~ ~exau~~ o 7~ ^u~ O CITY O F RE~BURG Arrreriau Farrrily Conrrnuuity 1~1 The CITY OF 1ZEXBURG has completed an annexation of lands at 839 West Main Street in Rexburg. The City is requesting that the Idaho State Tax Commission approve the map and legal description as contained in Ordinance No. 973, dated October 05, 2006. The Ordinance was published on the 07`h of October, 2006. Ordinance 973 has been included for your review. Thank you, CITY OF REXBURG ~~~ Blair D. Kay, City Clerk I31air D. Kay -City Clerk, 12 N. Center Rexburg, ID 83440 P. O. I3ox 280 Phone (208) 359.3020 ext. 313; I~ax (208) 359.3022 blairkl@rexburg.arg wivw.rexburg.org ~ ~ NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN, that a Public Hearing will be held before the City Council of the City of Rexburg, Idaho, Thursday morning, October 05t~, 2006, at 7:10 a.m., in the City Council Chambers of the City Building at 12 North Center, Rexburg, Idaho, regarding annexation of 839 West Main Street. On September 7, 2006, the Planning and Zoning Commission recommend to City Council annexation of both parcels at 839 West Main Street. Water and sewer services will need to be extended to the annexation parcels. Future road development will be as per the Ciry transportation plan as coordinated with Madison County. The property is located at 839 West Main Street in the Rexburg City Area of Impact, Madison County, Idaho, described as follows on the Annexation Map dated September 07th, 2006: Parcel No. 1 Beginning at the Northwest corner of Northeast Quarter (NE'/4) of section Twenty Five (25) Township Six (6) North Range Thirty nine (39) East, Boise Meridian, Madison County, Idaho; thence south 393 feet. This is the true point of beginning; thence south 267 feet; thence east 330 feet; thence north 267 feet; thence west 330 feet back to the true point of beginning. The proposed zone change for Parcel No. 1 (one) is from Rural Residential l (RR1) to Community Business Center (CBC). Parcel No. 2 Beginning at the Northwest corner of Northeast Quarter (NE'/4) of section Twenty Five (25) Township Six (6) North Range Thirty nine (39) East, Boise Meridian, Madison County, Idaho; thence south 393 feet; thence east 95 feet; thence north 393 feet; thence west 95 feet back to the true point of beginning. The zoning for Parcel No. 2 (two) is (RR1) Rural Residential 1. At such hearing the City Council will hear all persons and all objections and recommendations relative to such proposed approval. The City Clerk will also accept written comments at City Hall prior to 4:00 p.m. on October 04, 2006. This notice is given pursuant to the provisions of Section 67-6509, 67-6511 and 50-222 (Section 3, category A) of Idaho Code and all amendments thereof. ~~~~/~gy~, of September, 2006. p ............. eG9,~% ORpORgT~ - CITY OF REXBURG ~:~ ~: ., '~~ y .: ~O\~ Blair D. Kay, City Clerk /~y~E 'OF "~~nber 19, 2006 ////i~p~~i~i~i~p~~'61~ptember 30, 2006 • • NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN, that a Public Hearing will be held before the Planning & Zoning Commission of the City of Rexburg, Idaho, Thursday, September 07th, 2006, at 7:10 p.m., in the City Council Chambers of the City Building at 12 North Center, Rexburg, Idaho, regarding annexation of 839 West Main Street. Water and sewer services will need to be extended to the annexation parcels. Future road development will be as per the City transportation plan as coordinated with Madison County. The property is located at 839 West Main Street in the Rexburg City Area of Impact, Madison County, Idaho, described as follows on the Annexation Map dated September 07th, 2006: Parcel No. 1 Beginning at the Northwest corner of Northeast Quarter (NE '/a) of section Twenty Five (25) Township Six (6) North Range Thirty nine (39) East, Boise Meridian, Madison County, Idaho; thence south 393 feet. This is the true point of beginning; thence south 267 feet; thence east 330 feet; thence north 267 feet; thence west 330 feet back to the true point of beginning. The proposed zone change for Parcel No. l (one) is from Rural Residential l (RR1) to Community Business Center (CBC). Parcel No. 2 Beginning at the Northwest corner of Northeast Quarter (NE '/a) of section Twenty Five (25) Township Six (6) North Range Thirty nine (39) East, Boise Meridian, Madison County, Idaho; thence south 393 feet; thence east 95 feet; thence north 393 feet; thence west 95 feet back to the true point of beginning. The zoning for Parcel No. 2 (two) is (RR1) Rural Residential 1. At such hearing the Planning & Zoning Commission will hear all persons and all objections and recommendations relative to such proposed approval. The City Clerk will also accept written comments at City Hall prior to 4:00 p.m. on September 06, 2006. ~ ~ This notice is given pursuant to the provisions of Section 67-6509, 67-6511 and 50-222 (Section 3, category A) of Idaho Code and all amendments thereof. DATED this 18th day of August, 2006. CITY OF REXBURG {~?Gp~tPOR9T BY Q J ~ , KCB %,~~~~gTF..o~,.`oP;j,O~~~.` Blair D. Kay, City Clerk Published: August 22, 2006 September 02, 2006 2 Findings of Fact City of Rexburg 12 North Center Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022 Ora Green - 839 West Main Street Annexation & Rezone On August 11, 2006, Ora Green presented to the Rexburg Planning & Zoning Coordinator a Request and Application for an Annexation and Rezone located at 839 West Main Street to Community Business Centex and Rural Residential 1. 2. On August 18, 2006, the City Clerk sent the Notice of Public Hearing to be published in the local newspaper for August 22, 2006 and September 2, 2006. A notice was posted on the property and sent to all property owners within 300 feet of the above mentioned properties. 3. On September 7, 2006, Danna Green presented to the Planning & Zoning Commission for the City of Rexburg the request for Annexation and Rezone located at 839 West Main Street to Community Business Centex and Rural Residential 1. Thaine Robinson motioned to recommend to City Council to annex both parcels at 839 West Main Street, changing the zoning on area #1 to Community Business Center, and leaving the zoning on area #2 Rural Residential 1. Mike Ricks seconded the motion. None opposed. Motion carried. Instrument # 314304 REXBURG, MADISON, IDAiiO 2004-02 24 02:40:00 No. es: 3 RecoMed for : ORA GREEN - G AFFIDAVIT MARIIYN R. RASMUSSEN Fee: 8.00 p Ex-Offlclo Rscorder Dep STATE OF ) - - -- -- . __ - --~- - ss. COUNTY OF/f(~.~lS[~~1) , ~2~_.~ ~ s ~ ~c~ N , of , , being first duly sworn d oses and says• Sh was formerly the wife of ~- ~C-~/`', of ~ ,c«-4 , to whom she was arried T y , at sil , ~o wring her marriage t the said ,.~ ,they received as their community property, certain real p'Foperty consisting of: ****SEE ATTACHED LEGAL*** The re property was initial) conveyed to the said couple by Warranty Deed, dated ~ll ~ 'y 1 ~7~ .from which said deed was recorded _, records of ~~~, The said L~.a.t~t~ ~a.y scw'LV' ~~C--~ died Q ~ ~ ~~/ 9Q~'on at ~ r~r-~-~ .L~~~ ~eR ;cE-~ C.e~ being at said time a resident of ~ County, and upon his death title to the .~j4~o ~,~y~ aforementioned real property vested in affiant as survivor of said marital community and sole ~.(, heir of any separate property, and affiant has continued to own, hold, claim and possess the said property as her own, free from all claims of others, and during all of said time she has held the open, notorious, and peaceable possession of said lands, and every part thereof. Affiant further states t at a he time of the death of said ~ EN ,there were no existing creditors or claims ag~jnst her_ or affiant, and that~si ~ethe death of said tS - N ,she has paid all funeral expenses and ling obli tions of a d~and nature existing at the time of the death of CS ~r-~i~~ `7~EE~ ~~~~ ~_A~~~ iant f~rt~sr states th t she~Nas well and personally acquainted with the estate of said Cs"~''r~'~ mac" ~~ ~ C~6E,~ as awned and held by him at the time of his death, and that the entire value of his estate, including the real property above-men#ioned, did not exceed the sum of $ r Q. ao ,that all of said property was the community property of said decease and affiant, and that there is no outstanding inheritance t r Fed ral Estate tax due or npai by reason of the death of said ~S ~ ~ No probate pro edin wer ever held in the matter of the estate of said v(cs .~,~-.~- ,~ N ,deceased, in the State Courts of `"7` v or elsewhere, an affiant makes and records this affidavit for the purpose of establishing her ownership of the real property above-mentioned and the absence of any creditor's claims, inheritance taxes and Federal Estate taxes. DATED: ~._ ~. - a.~l- o y- S~~ of .~dtalr~o ~ tll.~'~ ~' ~-~~ S And $ i2:~~'~ ~e • mac' S .~ '~~~~i~sd~1W W~ ~`~ ~~~ / / / f ! 11 I I I U N ~ ~~~~` • -- - ---f . . ........ ......... .... .... - • IoAHO'bEPAA1; :: ~P.HEALiH ~NawEi~i~q~ _ ~~ - • ---•.,y-~. -,:;::'' ._ _,;.t_. ~- ~.. .-BUQFiiFA~TF1.POtICYAl1pVITALBT/j71_$IiG3~ ...''"r:; _'••~,•,' _ :.:A~• `-~8~'•;':,~~,Y _ '. _ ~ ~ C~RTI~ICA'I'~ ~~• D~.ATIH ~ ~~~ •.!: r •,~~:. '?? : "~ta.~, • • JAt~UA•RY 30, -i~995• e ~ I995•-0>~ ~ ••{'•v'`'' DaNa FAed'" - ... _ - .-Slate Flle No.= 46 3 - . ' -. CMARIryFS. SAR6ENT::Cs~jF~~"J•s~-_° •:n~~'} ^~°~ ~; ~ - ~~._.~. '...' _ ''..~: _ = - - .~. ._~~~•.._ ~. - ._.. _ . .-- •- •; '~:. .;'•: - ' - - 84- YEARS.;. -- ~ ~- ~ - ~'-`~ - - ref-yj Ii~y~'f1ltIF1` dRrIAACt i • JAFF. ~'~1', 1995 =- ~-- E ,' . f '495• ` €~~ ~` 0 ~ • ,,;; a ~ • 4+.- I91 r •IDAHO ' yw8-oec®Bai~Aw .~Matr #:_.~,.. .:_--.- ,• -_ ~ 1la: ~f7YlDfO11CE97 ,. =i Y? .r';. ~N~ .. ..pf "? i~ ` I -_-r. _ ~ .---- o~ r„ .: ~:,•"t ''"k .I " •' ._.. -~~ 'CnY, rOMIlI Qi LO0I117dN CPaE117H:.~'," ; , ,s a T'•:r ` . ~:,~ ~ ~ w-. E ARRIED. ~;HYWAS ._ - -- _«-. ~:, Q .. " : : r,.,:f.. -`': ., f. ~ :__ ,~;~: ~l, _ •~j •1••I~1H0 _.F/~' L' L~~, IDAHO • a®roaccsrnra ; . i .+g~,'~ . ; : -' '+.,'•, • I DA D• ~ , ~~i"•' flsr. ~ ` ., .;7 'l "' Sir r ~,~~Y~f: ,~' ~, ~• '. .: ~=~'. ~' ' H ; ~~ x s ' ''i3~6~' ~4'' r ~ ~H~fH~' 14` - - ~ •~" '` •' . _ rr • ,. :., ,u r.; r.. s , ARGENT ~.: . "," , ~ -,:-~~ G HARL E S S '~"~' ~ - _ - - -. - . . .. .: ~ •f•_ •_ aanpuce ~ ~ - ~;r. - >~,,,~.>-.. ... rMOr16t-tell IMILIEN PNAE ;y ~, :'~-.' - ~ ._ __ _ -- • '.. - - _ _ _ _ :..~ - - _ _ -_ - - - ~ =~ _ .- ; . T,~: .:. MATILDA .LARSEN . . _ _. .. _ " MMEANDAD0f~880FengtlApy .~- ••' ~ ,•.< ,-, ~ ~ -. ::•.:-~ r,;-- ~ ~ :, - :: ; FLAM~1 FUNE AL HO E ~ - :._~. .. g- '~:- :i ,~-.:~-_-. __. . ' - - . - - R N , ~!1~: t ' EXS11R6:.: ~.~~HQ ~}:`; - .. - _~~... ... M!1'1l000P OIaP'OBIIIGrr: ~~ "i''-'•: :};.` •r4. :~ .,~. `.~>y~yq• ,~, Inl I ' A:' ~ •' 3j }~' ?'44i• '' ' ` ~ -''yd -~~~~ _ ~~~'~,', -~ ~ -- ~~• --- ~~ - r • ~ ~ f.r,,• . ~ . M. ~~•4 - ~r~ ~ '~ q. ' • ? i••c•. ' 1' 'g 'g ~. Tdt~ill C E Mraa~yiraema,li,a .._ .,... _ t. ~ ~. ... . ' .. ,. .. '' .. 'r ~' -! - CONGESTIVE'.°'HEAR'C,;•~FytILURE ~ ~ 7 •~,+~ °'• .' ~. r ` ~ - 2`~.WEFyKS:%z: ~ €~, ~. - OLEro ..e r' ~ - e- ARTERIQSCLERUTIC HEART- DISEASE ~ ~ ii ~ ``~'r ' ~ ~ - - •~ ~' • .•''~ N: r'' `~ • . - :_'.~.: <.._=. SEV~RIIC:~WEEKS . orE ri~pr... mn..a,N,,, ~y: ,. ~: ..- . 9..'. :~ .7^hr.rr. OUE rO (v H~aviwquana aQ: _-_- - - -• - - , a. -_ _ -- _ - -_--~, onaEa~ic3Nir=~cMri coNDino~us con~t~,r~rio Ta oEana ~~ei . . ' -: ....=,, :_L-. •,_ . , •: ~ ~ r. NONELISTED ~ __ _' _ ;s~ - '~~.:' _ - -~~ . . , r, • r ~~i, '•' ~ , MME"OFCEA'nHER-- ~ J-.~_~. _. ,: i> ~ r. .. - _. ' r _ .. .. ~a ,e r+'. _ i~ ~ ~ :--~.~ap• ~ - _ 7RI:EOI~CEIdIMEq..'~ ~ - LESTER -J . PE r .•~;, ~ r~" ,..: ) `, , •, _._-,,,d-rt=x;, '~. ,• • ~ .. TERSEN, 'NnD. 2!~.' ''7~` .r~F_ J' ~~' '~•'' ~' :7;~$i Y`r''~ •a,{' f;jPHYSI4'~IAN, ~~i r~•, ,a ~ y' ~.il ; ~'. 04TE OFIMtRli'I - -- ~~-- - FOUi OFt - -- ~- . o~cwvrrowaF,raartwungr - _ - '~•=- ~-:°~' - - - .. ,. .. rurceofwaav Ovrruu~ri - ... _.. ._ '• ~ .r ;. . Y II!! Y' - ~,C''' .Mrr•s` ip`7'f.~.y~ ~n~. 10~.~..y~fi;?~: LAY: ~~'~F v;'.c~lyr ~•,.~,! ,. :~'. This ie a true a1Jp corltid APnpol~ti0'/1 .. ~: - ~ 'p~~6 'J ••:r • . - r _ - on nls.¢tN'tl)~lA~4~-8U~U q14• _ _- 't r~,t 87~~,T1~ -`~- , I~ T s ~ Q ;' f -DATE 1~Up.D;'FEBRUARY 11, 2004 .~. - _ _ ,~ . _ ire?,~;r~~.•; ,;• ,0 ` - ~ ~ this copy Is not used-iin6e prepared on angiaved badar" _ -..-. - `- - :7A1V~ S. SMITH' '~f 4! - _ j'' dlaplaylrrg stale seal and sl naturo o1 the R Nat: - ._ ................. .. -- 9 ~ "~,'~`- TATS ~E -' ___....--'-------::~ _.~.---_._.__-------------~- s REGISTRAR -, ~~_ e _