HomeMy WebLinkAbout954915This affidavit is given to evidence the death of L. DEE NIELD and JOAN NIELD, Trustees
of the L. DEE NIELD and JOAN NIELD REVOCABLE TRUST, dated August 11, 1998, and to
establish DEEANN GARDNER, Successor Trustee of said Trust.
The undersigned hereby certifies that the L. DEE NIELD and JOAN NIELD listed as
Trustees of the L. DEE NIELD and JOAN NIELD REVOCABLE TRUST are one and the same
persons as listed as decedents on the attached certified Certificates of Death.
And by virtue of that death certificate attached hereto and recorded as part hereof and said
Declaration of Trust, I do hereby declare that the conditions for Successor Trustee appointment have
been met and that pursuant to said Declaration of Trust, that I the undersigned DEEANN
GARDNER, am now authorized as Successor Trustee of said Trust to convey any assets of the Trust
particularly the property located at: Afton, Lincoln County, Utah, and more particularly described
as follows:
Beginning at a point 90 rods East of the Northwest corner of Section 35, Township
32 North, Range 119 West of the 6th P.M., Lincoln County, Wyoming, thence
running South 320 rods, thence West 90 rods, thence North 160 rods, thence East 33-
1/2 rods, thence North 144 rods, thence East 10 rods, thence North 16 rods thence
East 46 -2/3 rods to the point of beginning. TOGETHER with all water, water rights,
mineral rights, improvements and appurtenances thereon situate or in any wise
appertaining thereunto. Subject, however, to all reservations, restrictions, exceptions,
easements and rights -of -way of record or in use.
Dated this to of 2010.
RECEIVED 8/12/2010 at 3:55 PM
RECEIVING 954915
BOOK: 752 PAGE: 27
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING
COUNTY OF Lin CoIv
AFFIDAVIT OF TRUSTEESHIP
ss.
DEEANN GARDN I Successor Trustee of
the L. Dee Nield and Joan Nield Revocable
Trust
On this (et of i< s i 2010 personally appeared before me DEEANN
GARDNER, Successor Trustee, the signer of the above instrument who duly acknowledged to
me that she executed the same, by authority of said Trust.
Notary Public
DEBORAH SCHWAB NOTARY PUBLIC
County of
Lincoln
027
State of
Wyoming
My Commission Fxoisos July 21, 2014
5' �s�L,: e�R`.J'kR.f/�d�Rl'� ",�"'Ti'�gy t„pilyri•fh!T
fialkf
rgt,�i;<�.
�rl
CERTIFICATIO ITAL .RECORD
340.
(j This is a true certification of the document on file in the office of Vital
Recbrds Services, Cheyenne, Wyoming.
D ATE ISSUED: Apr 27, 2007
This copy is not valid unlessprepared on paper with an engraved border.
Decedent: State File Number: 2007 000111
Name: Joan Lorraine Nield
Gender: Female, Social Security Number:.
Date of Birth May 22, 1928 Age at the Time of Death: 78 years
Date and .Place of. Death:
Date of Death: January 09, 2007
City of Death: Afton
Additional Decedent Information
Place of Birth: Auburn, Wyoming
Residence: Afton, Wyoming
Marital Status: Widowed
Name of Father. Ciril D Cranney
Maiden Name of Mother: Minnie Marie Griffin
Informant: DeeAnn Gardner Relationship: Daughter
County of Death: Lincoln
Disposition:
Method of Disposition: Burial
Place of Disposition: Afton Cemetery, Afton, Wyomin
Cause of Death.
The immediate cause is listed on the first line followed by any underlying causes. Interval:
a
Pulmonary-Ern ol s Saddle Type Not Recorded
b) Cardio Pulmonary Disease
(c) Congestive Heart t Failure
Other Significant Conditions: Not Recorded
Manner of Death Natural Death Time of Death: 09:18
Certifier:
Name: .K. Paul Head, M;D
Address: 110 Hospital .Ln Afton;` Wyoming
Date Filed: January 15, 2007
G tcj
"Gladys K. Breeden �Y �tJ nis {l ar
i It .1
Deputy State Registrar 47" }f f ft:
f r —t�y
tx
y 144 4 41c raliarm Tavirl
CERTIFICATION OF VITAL RECORDh
LOCAL FILE NUMBER
1 DECEOEN rs LEGAL NAME (Include AKA's 0 any) (First. Middle, Last)
•L. DEE NIELD
4 SOCIAL SECURITY NUMBER::
34 LOCATION OF INJURY (Street and number, 1344 04 Town, Siete)
374 DATE CERTIFIED (Mo/DaWYS
09 7
380, REGISTRAR'S 5 U
257284
STATE OF VVYOMING
5a ,,0 G0 Last Beilhday
77
DEPARTMENT OF HE.ALTH
STATE OF WYOMING:.:
DEPARTMENT OrNEALTH
CERTIFICATE OF DEATH
54 LUNDER 130011
Months
Days
Han
2 06,0 3. GATE OF 0671-1(Mo/Day/Y8 (Spell Month)
MALE NOVEMBER 23, 2004
50, UNDER I DAV 6 ATE OF BIRTH (Me)Day/Yr)
Minutes
74 PLAGE OF DEATH (0,008 only one?
IF DEATH OCCURRED INA HOSPITAL IF DEATH OCCURRED SpMEVLHERE OTHER THAN A HOSPITAL
0 InpatiOnt 0 ER Outpalleni DOA 0 Hospie FaciliKr 0 Nu,sing Hobte Long Tenn OrmrEacillly fi3) Decormtt's Hon)6 ..i0 Other (Sabo,)
74. FACILITY NAME (II not Mstitution. give street and number) 7c. CITY:TOWN, 081004)014 OF DEATH 7d. COUNTY OF DEATH
10416 STATE HIGHWAY 238 :AFTON LINCOLN
8 BIRTHPLACE (City and s)aie or loreign country) 10 SURVIVING SPOUSE (II wile, give name pnor to firs1 marriage)
Marded set/if/8Mo 0.0
AFTON 7 WYOMING Dix4CeO, 01 tat, RA14N EY
EVER IN 8.5 120 RESIDENCE —STATE 136' 17 T- r OITV, TOWN OR LOCAL ION
MED FORCES?
WYOMING LIN'CO'LN (iLN
4XR
1 0 YES fl !Fr. 126. ZIP C000 124.60486 CITY
10416 -STATE HIGHWAY 238 ONES )ONO
13. FATHEF4S NAME 61,01, 88408, Ldel) 84. MOTHERSfiLOM EfELIOR TO FIRST MARRIAGE (Firsrddte, Las,
LEMUEL DEE ,,NIELD E "LENfP ,9NAND NELSON
,sa. INFORMANTS NAME 156 RELATIONSHIP ro:oeceosr 580 MAILING AIRES,t{Streetiml NumbeLCML. SLaM, ZM Corm
JOAN N SPOUSE .10416 HIOHWAY 23 G 8311C
16. METHOD OF DISPOStTioN 4 17e.PLIZE Lfilem 17b. LOCATION CITY OR TOWN AND STATE
.m
3 0 Burial °Dania. 0 Removal Iro wyonfing L
C3 ciensition %,...tleatea,biaeat Opine, m WYOMING
180 i g= r UREOF L21,1E6 1017 LICENSE;NO 188.NAME OF FAdpry,, 191;401)FIESS FACILITY h
EM-426 SCHWAB MORTItARY'''.- 44 EAST FOURTH -AVE. AFTON
20 ACTUAL R PFX,IMEOF^DEATH .21. DATE PRONOUNCED DEAD (Mo/0ay/Yr) 22,1886 FLHON9e40E0 13600 23, WAS CORONER CONTACTED?
0530 NOVEMBER 23, 2004\
OYES 3 t3 NO
CAUSE
arrest. resplralery /ores!, or venlrmUlarfibrifiation w4IhooI ahrming 448 efiology DO NOT ABBREVIATE. Enter OnliOnocausa on a fine.KAddat,Millonal fines 04,004 46 death
4 7, 3. 041 4 18 80810 (oKke a conkequenfite dry
LoAoPW ,'&y &tar S
00(8470 )or 008 Gonsaquente oly
C.ALA2Alke.s4A,T_I.r. rea..r
TART II:Enter olber signit nt conditions contributing 40 80047 404 ,40) resulting in the onced 01 01084,
C1 0 A0A)A.AY AATE/ky PfseA5E '11-1y,ERrE,Q3 ,p
26. %Nene AUTOPSY FINDINGS AVAILABLE TO COMPL ETE THE CAUSE OF DEATH? 27. DID TOBACCO USE CONTRIBUTE TO DEATH?
0 YES 0#o S, H: EE 1:1 YES X3 NO i 0 R 08ABL? 0 UNKNOWN
28:18 FEMALE AELED 1064 20...MANI■1:ffi 06 DEATH
Li NOI prognant Within pas, year 0 Not pregnant Cut pregnant 43 days io 1 year before dem, 30 Niiiiiii In nomicitt4
O P40941084 01 time ol dealb 0 Unknown tl plognant within the p054 8884 0 Accident 0 Pending investigation
El NM perms, but pregnani within 42 day, otrlea(h 0 Suicide 0 Could not bo detenwried
30. oare OF INJURY (Mn/Day/Yrl 31 TIME.OF INJURY 432 PLACEOF INJURY (046084n1'5 418400. 0606ltu0l10r841e, 6re:41, elL): 33. INJURY ATWORK?.
0 yes 0 NO
35 IF TRANSPORTATION ACCIDENT, SPECIFY
0 Dover Operalor 0 Permsotan
36. DESCRIBE HOW INJURY OCCURRED. AND IF TRANSPORTATION INJUF, THETYPE(S) OF VEHICLE(SLINVOLVED tAutomobilm piCkup, motorcycle/ ATyi.bicycle, 884
37a. CERTIFIER (Check only we)
20 PHYSICIAN —To 45040040105410010080.000450060104011 480. 4440 and pMoe, and due KIM° cause(o) and man0006IOIOd
acononien— On the basiXof examination, an iny opinion, death (GCUIrSd al Mb time, date ain0 place, and due tO ille causbts) anti Mannetalated
Signature of Cerblier
370. NAME, TITLE AND ADDRESS OF CERTIFIER (Type or pnnt)
DONALD...J.., KIRK -MD....110 HOSP.ITAL...LANE..AFTON,.. WYOMING 83110
35)4.0484 14086(1/60 BY REGISTRAR (McdOey/Yr)
This is a true and exact reproduction of the document on file in the office of Vital
Records Services, Cheyenne, Wyoming.
DATE ISSUED: D .2694 Lucinda McCaffrey
Deputy State Registrar
47/111M.:
STATE FILE NUMBER
JANUARY 17, 1927
25. WAS,AN AUTOPSY
P &FORMED?
10I,YES ONO O
This copy is not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar.
(029