HomeMy WebLinkAbout935909
_ _ ..=IVED 12/31/2007 at 12:56 PM
RECEIVING # 935909
BOOK: 682 PAGE: 535
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Affidavit of Trustee
000535
I, Beverly A. Lupcho, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date November 18, 1999, Mary L, Murray and Beverly A. Lupcho, by deed
of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on
November 18. 1999. in Book 438 of Photostatic Records on Page 494, conveyed to John W.
Baker and Beverty A. Lupcho, as co-trustees for the Baker Lupcho Family Trust dated April 13,
1998, the following described property situate in Lincoln County, Wyoming, to-wit:
The South Yz of Lot 9, Unit B, Commissary Ranch Subdivision, Lincoln County, Wyoming
That by reason of said conveyance aforesaid, John W. Baker and Beverly A. Lupcho, as
co-trustees for the Baker Lupcho Family Trust dated April 13, 1998, became the owners of the
above described land, and title thereto vested continuously in said co-trustees from the date of
conveyance described in said deed to the date of death of John W. Baker on the 22M day of
October, 2001. That by reason of and upon the death of John W. Baker, and pursuant to the
Administrative Provisions of the Trust, title to the above described real property vested in Beverly
A Lupcho, as the sole trustee.
Affiant avers and certifies that John W. Baker is the identical party named 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,£L day of ()ÆihAk<. 2007.
~/~k
. Severl A. Lupcho
State of
)ss.
County of
Subscribed and swom to before me, a notary public in and for said County and State, by
Beverly A. Lupcho, this _ day of , 2007.
WITNESS my hand and official seal.
Notary Public
My Commission expires:
.... fJIIc.... ~fIII/
/P / per-..$. , IJ £
Sublátbed end sworn to CorA- '..
Before· me on thls..L!-_ of Ol! C. -J0.J2J."
. Ll.e.-vL.SitI...'-,/ Â. l... L( P ~ t-I-O
penon.fly known to me or pRMId to.....
the basis of satisfactory .vidence.. lie...
....on(s) who .pp..... ...........
5Ignature~ ~ C( ~
(SRI)
~ ... ... - - ... P;'~IA-A ;"m; ... J
@ Commllalon" 1669728
í Notary Public· California ~
J RIverside County t
~ .... ~ ~_;o:m:..Ex~e~~2~ 2~0
RIVERSIDE, CALIFORNIA
000536
COUNTY OF RIVERSID~:E
~)
STATE FILE NUMBER
CERTIFICATE OF DEATH
ITATC 0" CAL"onHIA
U.II: BLACK INK ONLY/NO .R"sunlla, WHIT£OUT8 on ALTERATIONS
V..II tRIEY. 1/001
LOCAl.. RItGISTRATtON HUM.E~/
DECEDENT
PERSONAL
DATA
';;1:: .. D......'_..., 'G'.." T~;;;;:m 13~~~e;:;~"
~;;;;/~;;~.TH H H' DO Ice yY '0' A;; T.O. i ~::'~:i .::: I"'~:::ï~":~:: a. ;;:Ie r- DAn G' ;~~;;';o~/t D ~ e e. T' H~~~2
Bo .T....T. 0.. ølRTH '10. aOCIAL a.CURITY NO. --r II. MIUTAAY 8ERVICE 11.1. MARITAL STATue 113....UUCATION TUN. COMflU:TI:O
CA _. I ~ no 0 NG 0 UNo Married 16
14. RACE 18. HISPANIC .~CCI"'Y lie. .U8UAL EMI'LOyltR
WhIte 0 no [! ND Hughes Alreraft
17. OCCUPATION lB. KINO 0'" BuaIN... 1'1. YaAR2"0'1'f OCCUPATION
Proeurement Manager Aerospace
20. REa'D&NCE ISTRICT AND HUM.En OR LOCATION I
'1
USUAL
RESIDENCI:
52525 Wheeler Road
21. CITY
Anza
122. COUNTY 123. ZIP COOl 124. YAS IN· COUNTY 125. S'ATE 011 'OIlIJaN COUNTRY
Riverside 92539 16 I CA
I ~~5~~L;I;::1:~~;:~:'~:z::M~:.;;;~;~un,uH"" ."... '.-, ""'. ZI..
29. MIDDLE 30, '-"ST IMA.ORN NAMltl
ae. HAMil. RELATIONSHIP
INFORMANT
Beverlv Lupcho, Spouse
28, NAME OP SURVIVING .flOUSI:-I"IRST
SPOUSE
AND
PARENT
INFORMATION
38. NAMII: 0.. MOTHE,._PIRS'
Beverly
3'. NAMI 0" ,.ATHRn-FIR8T
-
Lnpcbo'
33. LAST
3.... .1"1'" .fATE
32. MIDDLI
John
William
BAker Sr
MO
38. MIDOLI:
37. LAST .MAIDEN,
38. .1"1'" ......T.
DISPOIITIONI_'
.JuAnita Marie
3.. DATE M MID 0, C C v ï 40. PLACE OF FINAL Ol8P08IT'ON
10/20;/2001 Rh'crsldc Nllllunl1l CCllleler)' 22495 Van Bnren Blvd. RiversIde, CA 92518
4'. TYPI 01" DI8POSITIONI.1 42. SIGNATURII Of' IEMBALMIR
Bailey
--
MO
Jl'UNERAL
DIRECTOR
AND
LOCAl.
REGISTRAR
43. LtCEN.1 NO.
CRlBU
~
Not emblamed
, '
-
44. NAMII OP' ,.UHIERAL DIRICTOR 4BF"Due.I'.4"4'.I!!HO".~' .I~ATURE "'.tLO;A~.R~::::~n1~' "
Cremallon Society orRiv Co " I.... ~ --:t-vt-aM-_ '" U
101. PLAeIl 0" DIEATH I loa. I,. H~SPITAL. SPIEC,P'Y ONEI I 103. .....CIUTY OTHER THAN ÞtOSftlTALI
Rancbo Sorln!!s Medical Cfr 0 IP IXJ ERIOP 0 DOA 0 ~~:~: 0 ~~=. 0 a,....
1011. .1'RIIET ADORE88-1a,.ftIlIET AND HUMPER OR LOCATION I
I ,
25500 Medlcn) Center Dr
~
47. DATil. M M, DOl C C Y Y
10/25/2001
104. COUNTY
PLACE.
0.
DEATH
Riverside
108. CITY
MurrietA
107. DIIATH WAS CAUSED BY, IENTER ONLY ONII CAUSE PIIR UN. "OR A. 8. C. AND 01
"M.I"'.ltYAL
snWIIN ONSIT
AND DIArH
~~~~~'ATE IAI Arferiosclerolie Cardiovascular Disease
Years
108. DlAtH II'PORnD TO CORON."
EI YIlES 0 No
200i~¿()t¡"UMn.
DUE TO c81
'". .ta...y PItRFORMIID
OVE' ~NO
1 10. AUTOPSY PERFORMED
o VE, ŒJ No
I f 1. UIID IN DETeRMINING CAUl!
Oy.. 0 No
CAUSE
OF
DEATH
DUE TO (CJ
DUE TO 4D)
112. OTHER .'ON....ICANT CONDITIONS CDNT"'UUTIHQ TO DIIATH BUT NOT ".LATED TO CAUal[ GIVEN IN t07
Abdolllinn) Aortic Aneur)'slll, IITN
113. WAS OPERATION "En"ORMED "'OR ANY CONDITION IN ITItM 107 eft I I.' I,. V." U8T TYPIt 0" OPII:IIATION AND DATI:.
-.
Angioplasty
--1--/1980
PHYSJ·
ClAN'S
CERTIFICA-
TION
I ,.... I ClflTI" THAT TO THI: _1t8T 0" MY KNOWL.
EOGIt DEATH OCCU.....:O ATTHII HOUR, DATI:
AND rlACE STATED ,.ROM THE CAUS.' IITATEO.
DItCIE:~N~ :~~~D:~ ~I"CI ¡ DIC~~N', ~:~ ;~~ :UYI
I
I
~ O. "'G.ATU.. A"O "TL. a. c.."....' /110. L'C..".", ..~.
11 B. TY..1t A"ENDINO ,.HYSIC.AH·. HAMB. MAILING ADO"....; XI"
'1:,'17. DATE MM/DD/CCYY
I CERTI" THAT tN MY OPINION DEATH
occunREO AT THE HOUR, DATIE AND ,.LACE
.TATED I"RoM THE CAUBII. STATED.
1 ,.. MANNER 01" DEATH
C&I "ATURAL 0 SUICIDE 0 HOMICIDE
O 0 PENDrNG 0 COULD NOT Sf.
ACCIDENT INVIUnGATION DETERMINED
'2S. LOCATION ISTR,EBT AND NUMBER OR LOCATION AND CITY. ZIP'
......
'20. INJURY AT WORK ,..,. INJURY DATE 1M lot I 0 Die é y Y I 1 aa. HOUR I' a3. "LACK OP INJU..Y
OfE8 ONO I '. I I I
1Z4. oEscnlDE HOW INJURY OCCURRED (CVENT. WHICH RE8ULt·.D IN INJURY) ....
CORONER'S
USE
ONL.Y
I
1118187
STATE'
RE.GISTRAR
1a.t.~UR. ~~R OR OEPUTY c~lIn
,.......- ~("" '-:;p. /t/~
A
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IC
D
IE
T';~i;:i;~~~/eeTY ~7~;;;'~~N;~' T;~,eG;;~~;; D~~;O;~";"E.
I' 1° H 'AX3;<;;;S9 . C"NOUSTRACT
CERTIFIED COpy OF VITAL RECORDS
ST ATE OF CALlFORNlA } 55
COUNTY OF RIVERSIDE
This Is a true and exact reproduction of the document officially registered and
placed on file In the office 01 County 01 Riverside, Department of Health.
Gary Feldman M.D.
Local Registrar
RIVERSIDE COUNTY, CALIFORNIA
DATE ISSUED
1 0 /3 1 / Z001
~1~ ~J)
This copy lIot valill unless preparell on engravell burlier lIisplaying seal and signalure of Registrar.
.
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