HomeMy WebLinkAbout957425RECORDING REQUEST BY:
JOHN R. REEDY, INC.
WHEN RECORDED MAIL TO:
JOHN R. REEDY, INC.
3434 Truxtun Avenue, #220
Bakersfield, CA 93301
APN:
State of California
County of Kern
RICHARD L. JEFFRIES, of legal age, being first duly sworn, deposes and says:
That DOLORES OPAL JEFFRIES, the decedent mentioned in the attached certified copy of death certificate, is the
same person as DOLORES O. JEFFRIES, named as one of the parties in that certain Individual Quitclaim Deed
dated May 18, 1988 executed by R.L.JEFFRIES and DOLORES O. JEFFRIES, wherein the decedent is Trustee
U /T /A RICHARD L. JEFFRIES AND DOLORES O. JEFFRIES, dated May 18, 1988; it being further
acknowledged that RICHARD L. JEFFRIES is the successor Trustee under said Trust. The aforementioned
Individual Quitclaim Deed was recorded May 25, 1988, as Document No. 688162, Book 262PR, Page 155, covering
the following described property situated in the County of Lincoln, State of Wyoming:
Plat Thirteen (13) Lot Eighty -Three (83) in Star Valley Ranch, as platted and recorded in the Official
Records of Lincoln County, Wyoming.
Dated: November 19, 2010.
State of California
County of Kern
Subscribed and sworn to (or affirmed) before me on this 19 day of November 2010, by Richard L. Jeffries who proved to
me on th:. sis of satisfactory evidence to be the person who appeared before me.
Notary
ss.
AFFIDAVIT OF DEATH OF TRUSTEE
RECEIVED 1/3/2011 at 11:54 AM
RECEIVING 957425
BOOK: 759 PAGE: 669
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
-V-4. -�D^IL c
RICHARD L. JEFFRIES, c e sor Trustee
000669
CHRISTINE M. SMILEY
Commission 1910916
Notary Public California g
Kern County
M Comm. Ex ires Ott 29 2014
CERTIFIED' COPY- OF VITAL.RECORDS
t t h STATE OF CALIFORNIA .I )ATE ISSUED C L
o q 7,A COUNTY KERN bF 1 its
t it This is a true and exact reproduction of the document officially 1 q'^
o y registered and placed on file in the.office of the VITAL RECORDS N CI
SECTION OF THE DEPARTMENT OF PUBLIC HEALTH S ERVICES,
.1. NAME OF DECEDENT -FIRST (0898) 2. MIDDLE :7. LAST (Famllr)
;DOLORE :S OPAL
JEFFRIES.
ANA: ALSO KNOWN AS lridudo 0! AKA (FIRST, MIDDLE „LAST) 4 DATE OF 818194 nON ry dd/cc S. AGE Yrs. I M 005 IF UN ONE Daye H.0 YFAR F UND01ra M0u1as
7 HOURS 6' SEx
02122/;1916.. 94 F
9. 810194 STATE/FOREIGN COUNTRY. 1'10 SOCIAL SECURITY NU 1.1. EVER 1N U.S. ARMED FORCES? 12 MARIT4LSTATUSSRDP' 6010604 Death) 7. DATE OF DEATH mm/dd/ccW 8 60015 (24 Ham)
CA I I' ..ye Xo6 LING MARRIED 10/29/2010 13:10''.
13. EDUCATKIN- HglwNewp
40rta 1U15. WAS DECEDENT HISPANICAAT (ly8,w »M
waiaeet bAS) 1 @.DECEDENTS RACE -Up 0.3 00005 may be 0;3194 Nee
wmkemeten.badd
"Mhas 00 back) CAUCASIAN
ASSOCIATE Y6
:17: USUAL OCCUPATION Type of work 1o, mo DO NOT USERETIREO 18. KIND OF BUSINESS 08 INDUSTRY 619., grocery 6 m
800, atl'0dnabvc6on, e0pkrym9nt agency,. et0,)' 19. YEARS IN OCCUPATION
HOMEMAKER OWN HOME I 69
BAKERSFIELD 1
21. CITY
26. INFORMANTS NAME RELATIONSHIP
RICHARD JEFFRIES, HUSBAND
.28. NAMEOF SURVMNG SPOUSE/SRDP'- FIRST•
:RICHARD
31. NAME OF FATHER/PARENT -FIRST
ANTHONY
35: NAME OF MOTHER/PARENT -FIRST
E ULALIE
39: DISPOSITION DATE: iinJdNecyy:
44. NAME OF FUNERAL ESTABLISHMENT
:BASHAM FUNERAL CARE
In death).:
Sequentially,, Itst
cnhdhbns; N any,
l ading to cause
Una A. Enter
UNDERLYING
CAUSE (disease or
INury that
lndiated Me 9096, LTA
resulting in death) LAST
114. ICERIFY714 T011ELEST(FM80q'OMEEEEHD00.fi®
8711EH3Ay DUE MDFK1*5W13)RCM11EC SW
(A): mmrdd./84y
10/26/20
36. MIDDLE
30:LAST (BIRTH NAME),
JEFFRIES
40 :PLACE OP FINAL DISPOSITION BAKERSFIELD :NATIONAL CEMETERY
30338:E'. BEAR MOUNTAIN BLVD: ARVIN 93:203:,
.101. PLACE OF DEA111..
RESIDENCE
126. SIGNATURE Of CORONER/ DEPUTY CORONER,..
1. 93309 29. ZIP CODE 24, YEARS IN COUNTY 25. STATE/FOREIGN COUNTRY
94 c
27. INFORMANTS MAIUNG ADDRESS teat nu
and mbel;LY,unlOUle number titian, state and Lip)
209 BERMUDA STREET, BAKERSFIELD, C :93309
42,.BIGNA11113E :OF EMBALMER:
NOT EMBALM
30. :iA5T 6310114 NAME)':
NOZZL
45. LICENSE NUMBER 46. SIGNATURE OF LOCAL REGISTRAR
FD1708 CLAUDIA'JONAH, MD
127. DATE. mnldNdyY
102. IF HOSPITAL, SPECIFY ONE
❑:P :[11 EW/OP a MA
.104. COUNTY 105. FACILITY ADDRESSOR LOCATION WHERE FOUND)SNeel'and number; orbs tion)
KERN 1 20 BERMUDA ST
107. CAUSE OF DEATH Enter lia Gut) of ewme-- GP36.es 0N6as, :0.006161 *NRil WO :00'10causeo deer.80.N,OT.Enta torm4ie1events
r eanGac boast, respiratory enest, o v nni:d t 0Mlletlon *Mi&d'6M'Ai5 the oli0gy. DO NOT ASBREWYTE
(MMEDIATECAUSE CARDIOVASCULAR ACCIDENT
con r e
condition resulting
112. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING 7O DEATH BUT NOT RESULTING IN THE UNDERLYING CAUSE GIVEN IN 107'
DEBILITY
1133 WAS OPERATION PERFORMED FOR ANY CONDITION-1N n014107 00 112? Olyas;9Mflype of 8Perdkmand SAn)
115. SIGNATURE AND'TI74E OF CEiR1fIEH
►RANDOLPH SENINING M D'.
116. TYPE ATTENDING PHYSICIAN'S NAME MAILING ADDRESS, ZIP CODE
R S NIN G
IN M.D.
`6501 TRUXTUNAVENUE, BAKERSFIELD, CA 93309 O
INIIIIINIIIIIIIIIIINNIIIMIIIgIIINIIIIIIIIIIHIIIIIIIIIIInlIIIIIIIIIIII
'010001001625573`
108, COY
BAKERS MELD
111$1010IM Boa<M:
omelAnd
DAYS
121. INJURY DATE mm/ddJKcyy
34. BIRTH STATE;
MD
30. BIRTH STATE
CA:
43. LICENSE NUMBER.
109.8108511 PERFORMED?
1131 FFENLE PFEGitJY4rNLASTYTNI?
•.116: LICENSE NUMBER, 117 DATE mo*ddIy
cc
.A71636
122. HOUR (24 Hours)
123. PLACE'OF INJURY(991., lame, corntrucllon site.)
124. DESCRIBE HOW :INJURY OCCURRED (Events which mulled In In)ury)
128.'LOCATION INJURY {SlreOt'afb'numbaTi dlbc411on, and city, and 81p)'.
PUBLIC HEALTH SERVICES DEPARTMENT
1800:MT. VERNON:AVE, BAKERSF:IELD, CALIFORNIA 93306 -3302
CERTIFICATE OF :DEATH 320101.5004081
STATE11F
USE RACK INK ONLY/ M� IEOUIS ORALIERATIQNS
STATE FILE NUMBER
20. DECEDENT'S RESIDENCE(S1re0Land numbs,, or locaton)
209 BERMUDASTREET
21. CITY
BAKERSFIELD 22: COUNTY/PROVINCE
KERN
STATE OF r' or 1 OI{NZA
CERTIFICATIO 1 ITAL RECORD
f U,BUC
LOCAL REGISTRATIONMUMBER
CLAUDIA JONAH, M.D.
HEATH OFFICERAND LOCAL REGISTRAR
OF BIRTHS AND DEATHS
imuruniim'w'
*0003.5: 25
Thi copy is.not valid unlessprepared on; engraved :border'display ng seal ancrsigniturei.of registrar 4
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