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STATEMENT OF TRUST AND
IDENTITY OF SUCCESSOR TRUSTEE
Pursuant to W.S. 34-2-123
000354
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
Lauri Ealey of PO Box 1312, Afton, WY 83110, upon her oath deposes and says:
1. That she makes this affidavit as her recorded statement, duly verified, pursuant to
the provisions of W.S. 34-2-123 and in connection with the following described real property
located in Lincoln County, Wyoming:
Part of Lot 2 of Block 21 to the Town of Afton, Lincoln County, Wyoming, being more
particularly described as follows:
Beginning at a point which is 99 feet South of the Northwest corner of said Lot 2 and
running thence East, 8 rods; thence South, 9 rods; thence West, 8 rods; thence
North, 9 rods to the point of beginning.
2. That the names of the grantee in that Warranty Deed dated December 11, 2003,
and recorded in the office of the Lincoln County Clerk on January 24, 2008, in Book 684, page 661,
Recording No. 936458, conveying the above-described real property is hereby stated to be as
follows: Frances Lacy Addison, Trustee, or her successors in trust, under the Frances Lacy
Addison Living Trust, dated December 11, 2003. The beneficiary of this trust is Lauri Ealey.
3. That her name and address is Lauri Ealey, PO Box 1312, Afton, WY 83110.
4. That she is a beneficiary of the trust referred to, that Frances Lacy Addison became
deceased on February 7, 2008, that a certified copy of the Certificate of Death is attached and
incorporated herein by this reference, that upon the death of Frances Lacy Addison, she became
the sole surviving trustee under the Frances Lacy Addison Living Trust, dated December 11, 2003.
RECEIVED 4/18/2008 at 11 :48 AM
RECEIVING # 938365
BOOK: 692 PAGE: 354
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
000355
5. That as of February 7, 2008, the date of death of Frances Lacy Addison, Lauri Ealey
became the sole surviving trustee under the Frances Lacy Addison Living Trust, dated December
11, 2003, including its ownership of the real property described above, and that she is currently
lawfully serving in that capacity.
6. That she hereby verifies that the information contained in this affidavit is true and
correct according to her information and belief.
DATED the r::Ls'-'- day of March, 2008.
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Lauri Ealey
Subscribed and sworn to by Lauri Ealey aka before me this ;;-ç.¡-/, day of March, 2008.
Witness my hand and official seal.
GERALD L. GOULDING - NOTARY PUBLIC
County 01
Uncoln
51aleol
Wyoming
~cY~
NOTARY PUBLIC
Mr (;Qmmission Expires Mav 2. aQ11
My commission expires: May 2, 2011.
2
STATE OF IDAHO
IDAHO DEPARTMENT OF HEALTH AND WElFARE
BUREAU OF HEALTH POLICY AND VITAL STATISTICS
000356
FEBRUARY 25,
CERTIFICATE OF DEATH
2008
Slale File No.
2008-01264
~EDENT . lEGAl NAME
MABEL FRANCES LACY ADDISON
FEMALE
SOCIAl SECURJ1Y NUMBER
I
AGE
77 YEARS
[lATE OF BIRTH
MARCH 26, 1930
PLACE OF RESIDENCE
MOVILLE, UTAH
~RI"Al STATUS AT TIME OF DEATH
AFT ON, WYOMING
NAME OF SURVIVING SPOUSE ßI "'fe. "",idon nome)
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
NO
DIVORCED
BIRTHPLACE
RALPH WALDO HANCHETTE
ILLINOIS
MOTHER . ~IDEN NAME '
~ .
MABEL FRANCES TRACEWELL
\
BIRTHPLACE
IOWA
REMOVAL FROM STATE
ICE liCENSEE
METHOO OF DISPOSITION
CORNELISON
NAME AND ADDRESS OF FliNERi\l FAClll1Y
SCHWAB MORTUARY, AFT ON, WYOMING
DATE OF DEATH TIME OF DEATH
F E B. 0 7, 2 0 0.1f
6:00 P.M.
COUNTY OF DEATH
IDAHO
BANNOCK "
CAUSE OF DEATH (underlying counl...).
a PNEUMONIA I
\
.,
~:'~)(~~I~~~rV.1 Between
DAYS
DUE TO (or 88 a con88qusncB of):
bALZHEIMERS.
~ DUE TO (Dr as a conllequencø 01):
c.
YEARS
DUE TO (or 88 a consequence of):
d.
/
OTHER SIGNIFIC.ANT CONDITIONS CO!'lJRI8UTING TO DEATH but no' resulting in the undorlying ,",ueo given above
NONE STATED
/
WAS AN AUTOPSY
PERfORMED?
NO
~NNER OF DEATH
NAME OF CERTIAER
TITlE
PHYSICIAN
,NATUR' L
SUSAN CLARKE LEE, M.D:. ,I
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
.--
LOCATION WHERE INJURY OCCURRED
DESCRlPTIONOFtlOW INJ\R( OCCURRED
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This Is a true and correct reproduction of the document officially registered and placed
on file with the IDAHO BUREAU OF HEALTH POLICY AND VITAL STATISTICS.
FEBRUARY 26, 2008
DATE ISSUED: 1
a ~~;>ð~
JANE S. SMITH
STATE REGISTRAR
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This copy not valid un)ess prepared on engraved border
displaylng·state seaVand signature of the Registrar.
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