1 March 2016 Repeat Customers: Please check changed address? **_____ changed email address? **______ old address: ____________________________________________ SAMPUBCO ORDER FORM - Letters of Testamentary Name:___________________________________________________________________________ Email (REQUIRED!):______________________________________________________________ Street/P.O. Box:________________________________________________________________ City/State/ZipCode+4:___________________________________________________________ (out of USA - City, Province, Country, Postal Code) Order (do NOT alter the information as listed in any way): Name of Person: Residence: County of Record: State, County # Vol, Page # Example: DOE, JOHN Anyplace Anycounty XX-50-35-80 Example: DOE, JOHN - Anyplace - NY-14-2-000 1.______________________________________________________________________________ 2.______________________________________________________________________________ 3.______________________________________________________________________________ 4.______________________________________________________________________________ 5.______________________________________________________________________________ Scanned Copy - send by Email Cost: $5.00 if paid through PayPal/Credit Card $7.00 if paid by check Paper Copy - Not available Number of records: _______ X USD $_____ = ______________ check / PayPal /eCheck Please Do NOT staple or tape check to the order. Please do not combine with naturalizations, wills, or guardianships. Please do not staple or tape check to the order. CHECK MADE OUT TO: SAMPUBCO Mail to: W DAVID SAMUELSEN 629 S HARMONY CT Salt Lake City, UT 84102-3446 STOP! Please check and verify the accuracy of the information. Do NOT forget to list "County of Record", which is listed at top of the index page the indexed information is found on.