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WHEN RECORDED MAIL TO:
OOö294
McCrary Law Offices, LLC
111 West 2nd Street, Suite 615
Casper, WY 82601
QUITCLAIM DEED
I, ROGER C. DEBLOOIS aka ROGER CLARK DEBLOOIS, a single person, 13276 East 54th Street,
Yuma, AZ 85367, as GRANTOR(S) for and in consideration only of the payment of one
dollar ($1), and other good and valuable consideration, the receipt and sufficiency of which
is hereby acknowledged; hereby CONVEYS AND QUITCLAIMS to ROGER CLARK DEBLOOIS,
Trustee, or his successors in trust, under the ROGER CLARK DEBLOOIS FAMILY WEALTH
TRUST, dated December 16, 2008 and any amendments and restatements thereto.
The named beneficiaries being ROGER CLARK DEBLOOIS, then as set forth in the trust.
Address of GRANTEE(S): 13276 East 54th Street, Yuma, AZ 85367, the following
described real estate together with all buildings and improvements thereon situate subject to
all easements, reservations and restrictions of record, in the County of Lincoln, State of
Wyoming, to wit:
LEGAL DESCRIPTION:
See Exhibit A, attached
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Dated this \-"2-\- D9
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STATE OF~20'''c\''-
COUNTY OF \Å..)~
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The foregoing instrument was acknowledged before me on \-"2.\ -0<1 by ROGER CLARK
DEBLOOIS, as Trustee, of the ROGER CLARK DEBLOOIS F AMIL Y WEALTH TRUST.
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W - A
Signature of Notarial Officer
Notary Public
Title and Rank
RECEIVED 2/12/2009 at 11:41 AM
RECEIVING # 945232
BOOK: 715 PAGE: 294
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
EXHIBIT A
000295
PROPERTY ADDRESS: Unknown
LEGAL DESCRlPTION:
Lot 182 of Star Valley Ranch RV Park PLAT 1 as platted and recorded in the
official records of Lincoln County, Wyoming, together with all improvements
thereon situate.
Subject to any reservations, restrictions, covenants, conditions and easements of
record.
00&296
AFFIDA VIT OF SURVIVORSHIP AND TITLE
ROGER CLARK DEBLOOlS, also known as ROGER C. CLARK, of lawful age and being first duly
sworn upon his oath deposes and states as foHows:
1. That he is a person with personal knowledge of the facts hereinafter set forth;
2. ROGER CLARK DEBLOOlS, also known as ROGER C. CLARK, and MAXINE C. DEBLOOIS. also
known as MAXINE ANN DEBLOOIS, husband and wife. hereinafter described as tenants by the
entireties or as joint tenants with right of survivorship. purchased Real Property.
Property is described as: Lot 182 of Star Vaney Ranch RV Park PLAT I as platted
and recorded in the official records of Lincoln County, Wyoming, together with all
improvements thereon situate.
Subject to any reservations, restrictions, covenants, conditions and easements of
record.
3. On January 8, 2008, MAXINE C. DEBLOOIS, also known as MAXINE ANN DEBLOOIS. passed
away, thus ending such tenancy; a certified copy of her death certificate is attached. Said
property then became the sole property of ROGER CLARK DEBLOOIS, also known as ROGER C.
CLARK.
4. This affidavit is made in support of the Title to the above described Real Property being
transferred into the name of ROGER CLARK DEBLOOIS, also known as ROGER C. CLARK.
5. Further affiant sayeth not.
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STATE OF o.n~00CL
COUNTY OF ~\ lJ'""'1"O.-
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The foregoing instrument was acknowledged before me on \...."2."\ -oL by ROGER CLARK
DEBLOOIS.
~ESS ~
(Seal) Signature of Notarial Officer
Notary Public
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