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WHEN RECORDED MAIL TO:
MARLENE D. NIEDERHAUSER
244 East San Rafael Place
St. George, UT 84790
Order No.: 162086
Tax Serial No: SG- RIOV -4 -254
STATE OF UTAH
SOUTHERN UTAH TITLE
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"People You Can Trust in a Changing World"
County of Washington
AFFIDAVIT OF TRUSTEE(S)
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RECEIVED 8/26/2011 at 12:36 PM
RECEIVING 960714
BOOK: 771 PAGE: 670
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
This document has been recorded
electronically. Please see the attached Dopy
to view the County Recorder's stamp as it
now appears in the public record.
Date ia011 Entr DO( 00(30'77
Space Above This Line for Recorder's Use
COMES NOW, MARLENE D. NIEDERHAUSER, UPON FIRST BEING DULY SWORN, UPON
HER /HIS OATH DEPOSES AND SAYS:
1. That MARLENE D. NIEDERHAUSER is a citizen of the United States over the age of 21
years and a resident of St. George, County of Washington, State of Utah.
2. That she is the daughter of VIRGIL GENE DAVIS, who passed away on the 24th day
of November, 2010, and whose death is evidenced by the attached Certified copy
of Certificate of Death.
3. That VIRGIL GENE DAVIS, also known as VIRGIL G. DAVIS, whose death is evidenced
above, is one and the same person as that certain individual who acquired the real
property shown below, as Trustee of the THE VIRGIL AND DOROTHY DAVIS FAMILY
TRUST dated the 19th day of March, 2010, by Deed recorded April 26, 2010, as Doc
No. 2010001330, Official Washington County Records:
See Exhibit "A" attached hereto and made a part hereof.
4. That according to Section 7.6 under THE VIRGIL AND DOROTHY DAVIS FAMILY
TRUST dated the 19th day of March, 2010, that upon the death of VIRGIL G. DAVIS,
MARLENE D. NIEDERHAUSER, was to be appointed the Successor Trustee; that the
above described Trust is still in full force and effect and that by operation of said
Trust, MARLENE D. NIEDERHAUSER is the Successor Trustee of THE VIRGIL AND
DOROTHY DAVIS FAMILY TRUST dated the 19th day of March, 2010.
DATED this 19th day of April, A. D. 201
MARLENE D. NIEDER USER
See Additional Page for Notary Acknowledgment.
Attached to and made a part of that certain Affidavit executed by MARLENE D.
NIEDERHAUSER.
Order No.: 162086
Tax Serial No: SG- RIOV -4 -254
STATE OF UTAH
ss
County of Washington
My Commission Expires:
5. NOTARY PUBLIC
JILL N CANNON
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V...„ r'S1 ST. GEORGE, UT 84790
'%;w MY COMM EXP 05/01/2012
STATE OF UTAH
NOTARY
THE foregoing instrument was acknowledged, subscribed and sworn to before
me by MARLENE D. NIEDERHAUSER this 1 9th day of April, A. D. 2011.
otary ublic
No .ryPublic residing at:
Exhibit "A" Legal Description
0006'71
All of Lot 254, RIO VIRGIN R.V. PARK PHASE 4, according to the Official Plat thereof, on file
in the Office of the Recorder of Washington County, State of Uah.
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DECEDENT INFORMATION
Date of Death: November 24, 2010
City of Death: St. George
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
83
Evanston, Wyoming
Yes
Dorothy White
Railroad
St. George, Utah
Mother's Name: Cora Daniels-Brown
Date Issued: November 29, 2010
e &4
Barry E. Nangle
State Registrar
CERTIFICATE OF DEATH
State File Number: 2010013514
Virgil Gene Davis
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
Facility or Address: Elderberry Care
INFORMANT INFORMATION
Name: Marlene D Niederhauser Relationship: Daughter
Mailing Address: 244 East San Rafael Place, St George, Utah 84790
DISPOSITION INFORMATION
Method of Cremation
Place of Disposition: Metcalf Mortuary, St George, Utah
Date of Disposition: November 30, 2010
FUNERAL HOME INFORMATION
Funeral Home: MetcalliMortuary
Address: 288 West St Georg d Blvd, St George, Utah 84770
Funeral Director: Quinn M Hadley
MEDICAL CERTIFICATION
Medical Professional: Joshua Frame DO, 1490 East Foremaster Drive, #210, St George, Utah 84790
CAUSE OF DEATH
Failure to Thrive [Onset: 4 VVeeks]
Due to (or as a consequence of): Myasthenia Gravis [Onset: 7 Months]
Tobacco Use: Non-user
Medical Examiner Contacted: Yes Autopsy Performed: No Manner of Death: Natural
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14:47
Washington
September 19, 1927
Male
Married
Engineer
High School or-GED
Hutkert 0 Davis
Nursing Home/Assisted Living
This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V R images in top cycloids,
ultra viblet fibers and hologram image of the Utah State Seal, over the words "State of Utah".
This document displays the date, seal and signature of the State Registrar of Vital Statistics.
UTAH DEPARTMENT OF HEALTH
Office of Vital Records Statistics
Salt Lake City, Utah
Exhibit A
File 6011120114 Description
The land referred to in this document is situated in the State of Wyoming, County of Lincoln, and is
described as follows:
LOT 32 OF STAR VALLEY RANCH PLAT 12, LINCOLN COUNTY,WYOMING AS
DESCRIBED ON THE OFFICIAL PLAT FILED ON AUGUST 10,1977 AS INSTRUMENT
NO. 496703 OF THE RECORDS OF THE LINCOLN COUNTY CLERK.
000673