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RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
Dale H. Dawson, Esq.
DAWSON, PASSAFUIME, BOWDEN & MARTINEZ
4665 ScoUs Valley Drive
State ScoUs Valley, CA 95066
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Mail Tax Statements to:
RECEIVED 8/4/2006 at 10:35 AM
RECEIVING # 920952
BOOK: 629 PAGE: 50
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Gerald Channing Griffiths, Trustee
2611 Huntington Dr.
Aptos, CA 95003
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AFFIDAVIT - DEATH OF TRUSTEE
ACCEPTANCE OF SUCCESSOR TRUSTEE
GERALD CHANNING GRIFFITHS, of legal age, being first duly sworn, deposes and
says:
1. That RICHARD MANSEL GRIFFITHS, the decedent mentioned in the
attached certified copy of Certificate of Death, is the same person as RICHARD M.
GRIFFITHS named as the Trustee in that certain RICHARD GRIFFITHS 1999 TRUST,
executed June 11, 1999, and on that certain Grant Deed, executed June 11, 1999,
recorded as Document Number 859328, in the Official Records of Lincoln County
Wyoming, on June 17,1999, relating to the property situated in the County of Lincoln, State
of Wyoming, and more particularly described on Exhibit A attached hereto and incorporated
herein.
2. The undersigned, GERALD CHANNING GRIFFITHS, is the duly appointed
successor Trustee of the Trust referenced in the recorded document, and hereby indicates
his acceptance of the office of Trustee of the Trust referred to above.
1
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This Affidavit and Acceptance is executed this 'J. 4 day of J I-( 1)/ ~ t;
2006, at Scotts Valley, California.
State of California )
) ss.
County of Santa Cruz ) 1t:-,
SUBSCRIBED AND SWORN TO before me this£ ~y of J {,¿ b ,2006, by
GERALD CHANNING GRIFF S, personally known to me or proved on the basis of
satisfacto . enc to be e per on who appeared before me.
~....._----_........................~
\t JANEL. DAWSON .
..... Commission"1366799'
¡ .,,; . Notary Public. California ~
Santa Cruz County
, , My Comm. Expires Jul27, 2006
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COUNTY OF SANTA CRUZ ò'"'no~-~
SANTA CRUZ, CALIFORNIA
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CERTIFICATE OF DEATH
surE OF CAUFOANI..
USE BlACK IN ( ONLY I NO EFI....SUAES. WfilTEOUTS OR "'LTERA.TIONS
VS'11 (REV 1104)
3-2006~44-000690
LOCAL REGISTR....TION NUMBER
Manse~
19. YEARS IN OCCUPATION
2$
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34. BIRTH STATE
CA
36. BIRTH STATE
CA
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fig 06/16/2006
~ ~ 41. TYPE OF DlSPOSITIQN(S¡
;;1 ~ CR/RES
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"'0
~ -' Santa Cruz
CA 95003
-13. LICENSE NUMBeR
47_ DATE mm/ddlçcyy
06/16/2006
tOl. PLACE OF DEATH
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Residence
104. COUNTY
Scotts Val~ey
107. CAUSE OF DEATH
Enle'i'lhe ch¡.in 01 "'''eO)I& no diseau&. ¡nJutle.. or c,Qmpílcål¡~. __ thafdi.,eclly c.........d d...th,. DO NOTo.ntar loI.minoill .".nll¡_ suc:t¡,
a6,cilrtJia.:: ar~e¡OI..e~pìt( I,9ry ~rre6t. o~ :v.nlrlcular,~lbr~lIaUon ~llh_outlih.!l~!!S¡ thil atiologY::DO NO~ABBAEVIATE" . .'.. ' . .., .' .
Ti7''':''Int........1 Ðillwilen10a. DEATH REPORTED TO CORONER?
j'Oo.sel ¡wd De.lh W YES 0 NO
AffUiRAltnU.\ilEA
R-06-0313
IMMEDIATE CAUSE (AI
r~d;'u~~~::~I~~g -.
in death)
.:-. '~-'" .<:)~,;.¿,:, "';
-Arrnythmia
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(el __
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109. BIOPSY PERFORMED?
DYES GL] NO
110. AUTOPSY PERFORMED?
DYES ~NO
111. USED IN DETERMINltJG CAUS~1
DYES 0NO
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SaQuel1li,IJly. list
;::ondillo;lnl>, If anY.
16ading 10 cause
on Line A. Enter
UllDERLYING
CAUSE (diSIIßMlg.
In u..../ thaI
Initiated the .venlS
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Diabetes Mel~itus. Slee:pAp~1.ea. A~coho~isxn
11'3. WAS OPERATION PERFORMED FOR ANY COr!PtTIQN IN ITE~\ 107 ÖFt 1121 {II ya.. 1¡.ltype of CopQr.llon and dllll1o;}
no
114_ 1 CERTIFY THAT TO THE 6ES r OF MY KNOWLEPGE J?'''''iH. CCCUFlHED
AT THE HOUR. DATE. AND PLACE SlJ,TED f;AO¡'1 THE (.';'l.JS:~$ STATEQ.
115. SIGNATURE AND TITLE OF CERTIFIER
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118_ TYPE ATTENDING PHYSICIAN'S NAME. MAILING ADDRESS. ZIP CODE
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04/16/01 : 06/06/2006 2025 So ue~ Dr.. Santa
119_ CERTIFY 1H.\1 IN MY OPINIDI~ DEATII OCCURRED..T T~IEHDÙR. PATE, AND PLACE STATED FROM THE CAUSES STATED
MANNER OF DEATH 0 Nalural D Accid..nL D HOf~i¿id. D Suicld" D in~~~¡17:iluon D ~~~I,~~~~:.
Cruz"
120. INJURED Al- WORK?
DYES DNa DUNK
125. LOCATION OF INJURY (Slreel and numbar. O' Icoo,;.iI\On. ~nd clly. Bnd ZIP)
121_ DATE mm/ddlccyy
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CERTIFIED COPY OF VITAL RECORD
} .SS DATE ISSUED J U N 1 6 2006
exact reproduction of the docume~t officially registered and
in the Vital Records Section, Santa Cruz County Public Health
111/1111111111111 IIJIIIIIIIIIIII 111111/1/1 Ifill 1III1I11
*000165842
7ot;. ~~
CHIEF PUBLIC HEALTH OFFICER
SANTA CRUZ, CALIFORNIA
~ot valid unless prepared on engraved border displaying seal and signature of Registrar.
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'0920952
EXHIBIT "A"
Lot 243 of the Lakeview Estates, Tract "A", a subdivision
of the S~SE~ of section 29, T37N, Rl18W, 6th P.M.1
Wyoming, according to that plat recorded in the Office of
the Lincoln County Clerk.
,
,
Subject to reservations and restrictions contained in the
United states Patent and to easements and rights-of-way
of record or in use.
Together with all improvements and appurtenances thereon,
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