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Affidavit of Successor Trustee
I, Fred A. Crook, being of lawful age and duly sworn according to law,
upon my oath, depose and state:
That under the date of October 24, 1990, for valuable consideration,
Newell Crook and Mary Crook, by deed of that date, which deed was duly filed of
record in the Office of the Lincoln County Clerk, on October 25, 1990, in Book
291 of Photostatic Records on Page 173, conveyed to Newell H. Crook
Revocable Trust, dated the 6th day of August, 1990, Newell H. Crook and Mary
E. Crook, Trustees, the following described property to-wit:
Plat 21 Lot 64 in Star Valley Ranch as platted and recorded in the
official records of Lincoln County, Wyoming
That by reason of said conveyance aforesaid, the said Newell H. Crook
Revocable Trust, became the owner of the above described land, and title
thereto vested in Newell H. Crook and Mary E. Crook, Trustees, continuously
from the date of conveyance described in said deed to the date of death of
Newell H. Crook, on the 20th day of May, 1995. That by reason of and upon the
death of Newell H. Crook, title to the above described real property vested in
Mary E. Crook, as the trustee. That Mary E. Crook is unable to act as the
trustee. Pursuant to sections XII and XVII (4) under said trust agreement, Fred
A. Crook is the successor trustee.
Affiant avers and certifies that Newell H. Crook is the identical party in the
aforementioned deed whose death terminated his 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 4- day of D~'r
,2005.
y~A td Crook
I
q.
Stateof~
)ss.
County of :;q It LOt ~e. )
Subscribed and sworn to before me, a notary public in and for said County
and State, by Fred A. Crook, this L day of --'kd::nJ2r/.... , 2005.
WITNESS my hand and official seal.
NOTARY PUBLIC
SCOTT LARSEN
3505 South 8400 West
Magna, Utah 84044
My Commission Expires
May 8, 2008
STATE OF UTAH
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. otary Public
My Commission Expires: ---lli (A'I 8' I ?Df> (0
RECEIVED 10/11/2005 at 3:45 PM
RECEIVING # 912647
BOOK: 600 PAGE: 686
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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DECEDENT
PAr.~tITS
INFORMANT
DISPOSITION
CERTIFIER
REGISTRAR
CAUSE OF
DEATH
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LOCAL FILE NUMBER
18-1981
STATE OF UTAH - DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
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STATE FILE NUMBER
I. UAME OF DECEDENT FIRST
MIDDLE
LAST
CROOK
b.l1ME OF DEATH f24h1, ClOd<)
0545
7. SOCIAL SeCI.:'RITY NUMBER
Freedom, Wyoming 520-09-7451
Bb. NAME OF HOSPITAL. NURSING HOME OR OTHER FACILITY (If outside _ f.cility,
give s1'6el _dd'8SS of location}
Se t. 17, 1914
I AL:
o Inpllienl 0 ER'OuIPllienl 0 DOA
8c. CITY. TOWN OR LOCATION OF DEATH
ŒI Nursin Home 0 Resldene.
ed. COUNTY OF OEA TH
o O"or South Valley Care Center
9. SURVIVING SPOUSE (if w;f., øivenniden nøme)
West Jordan
10. WAS DECEDENT 11. MARITAL STATUS
~VR~~I~ ~Ò~CES? 0 Never Maflied
¡j Vo. 0 No 0 Di"",cod
Salt Lake Mary Ellen Matthews
120. DECEDENrs USUAl OCCUPATION (Give kind 01 work done 12b. KIND OF BUSINESS OR INDUSTRV
during moSI of working lite. 00 NOT use rei ired)
lID Married
o Widowed
Rancher
13b. CITV. TOWN. OR COMMUNITY
Dairy
13.. RESIDENCE· STREET AND NUMBER
13c. COUNTV
13d. STATE
Wyoming
16. EDUCATION (Specilyonlyhighesl grad
completed) E$ementary or Secondary
(0·'2)·CoIlege (13·16 or 11 +)
RFD
130. INSIDE CITY 131. ZIP CODE
LIMITS? .
Etna
14. WAS DECEDENT OF HISPANIC ORIGIN1 0 Yes
(II yes. specify)
Lincoln
o Ves IXI No
o MI.ican 0 Cuban 0 Puerto Rican 0 O1her (SpBcjr~" Whi t e
18. MAIDEN NAME OF MOTHER (Flr¡t. Middle. Lastl
83118
14
17. FATHER'S NAME (Fils!. Mlddl'. Last)
William Henr Crook
19. NAME. RELATIONSHIP AND MAiliNG ADDRESS OF INFORMANT
Fred A. Crook, Son, 9340 Betty Drive, West Jordan, Utah 84088
20. METHOD OF DISPOSITION 21a. DATE OF DISPOSITION 21b. PLACE OF DISPOSITION (Name of cemele 21C. LOCATION. City ollown, SIal8
o Entombment' DDonalion 0 Oth.r cremalory. or other plac'J
Annie Evelyn Haderlie
1995 Freedom Cemetery Freedom, Wyoming
23. LICENSEE NUMBER 24. FUNERAL HOME (Name. address .I"Id license number)
115349
Goff Mortuary, Inc. 0101222
8090 South State Street
Midvale. Utah 84047
26. If not cenified by medical examiner. was dea1h reponed to M.E.? 0 Yes
II ye5. enter the date .I"Id hour reponed: M.E. Clse No
5-/5"-;h
21a. C R I
Ui CERTIFVING PHYSICIAN
To rhe besl ot my knowledge. dealh occurred althellme. dale. and place. and due 10 Ihe c8usefs) and manner as staled.
T
Ii and/or investi alion in m
HO.
...
OAY
v A.
31.
IMMEDIATE CAUSE (Fmal
disease or condition
resulting In death)
Appro_.male InleNal
Salween Onsel And
I Dealh.
I 4()ð:1h.-
I
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I
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Sequentlatly lisl condilions. .
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CAUSE. (disease or injury .
thai ",¡I,ated eO'er.:s reSu/1ing
in d8e/h) lAST
--oÜËTQloRÃiAëõÑseouENCE OF):
DuE TO lOR AS .. CONSEOUENCE OF,:
------
PART II. ~her Slgniflcanl COndn'ons conlributlng to dUlh but nor
,.sulling In the underlying c.aaSf 9''''" in Pan 1
-~-ic...he.tE5____________
32. IN VOUR OPI"'ON. TOBACCO USE BY THE DECEDENT 330. WAS AN 33b. WERE AUTOPSY
o Probably contributed 10 Ihe cause of death ~~~~6~~ED? þ~g~¥g ~~~t~~~ON
o Was 1he underlying cause of dealh OF CAUSE OF DEATH?
o ~i~~:~::~I;~b~~~:~~h,: ~~~::~:::~I:ealh 0 NON.USER ~ VltS 0 No Yes 0 No
3Sb TIME OF INJURY 3Sc. INJURY AT WORK' 35d. PLACE OF INJURY-AI home. farm. slreet. factory.
2.J HOllr Cloc/d offIce, building. elc. (Specify'
3~. MANNER OF DEATH
(gI Nalural 0 AweSe"1
3S. DATE OF INJURY
(MonJh. D~y. Year)
o Suicide
35e.lOCATION (SI,ee, or rura' rou'e number. CI'Y or '0",1"1, coun,y and state)
350· II mOlor vehicle accident SPðCify it decedenl WIS
driver. passenger or pedeslrian.
o Homrcide
o Undelerm.ned
II Injured
Purposely 01
Acctdenlally
o Pend'ng
Jrw.st'Q.lion
This is to certify that this is a true copy of 'the
information on file in this office. This èertified
copy is issued under authority 9tSection 26-15-26
of the Utah Code Annotated,1953 as amended.
Date Issued
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