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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
SOUTHERN UTAH TITLE
SUMO
"People You Can Trust in a Changing World"
AFF /DA WT OF TRUSTEE(S)
STATE OF UTAH
County of Washington
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 DOROTHY JEAN DAVIS, who passed away on the 21st
day of January, 2011, and whose death is evidenced by the attached Certified copy
of Certificate of Death.
3. That DOROTHY JEAN DAVIS, also known as DOROTHY W. 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. 20100013301, 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 DOROTHY W.
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. 2 1
RECEIVED 8/26/2011 at 12:46 PM
RECEIVING 960715
BOOK: 771 PAGE: 674
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
ss
This document has been recorded
electronically. Please see the attached copy
to view the County Recorder's stamp as it
now appears in the public record.
000674
late I/ 2a I I En try a-a t t o I ao
Space Above This Line for Recorder's Use
MARLENE D. NIEDER AUSER
AJ%
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
THE foregoing instrument was acknowledged, subscribed and sworn to before
me by MARLENE D. NIEDERHAUSER this 19th day of April, A. D. 2011.
My C
f��4OF �N6. NOTARY PUBLIC
JILL N CANNON
1224 S. RIVER RD. STE A -101
t x s1 ST. GEORGE, UT 84790
s; •e :'•;i' MY COMM EXP 05 /01/2012
ommtikron Expire$TATE OF UTAH
NOTARY
It/U/V-A
Nota y Pub •c
Notaryl• residing at:
000675
Exhibit "A" Legal Description
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 Utah.
CERTIFICATI VITAL RECORD
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DECEDENT INFORMATION
Date of Death:
City of Death:.
Age:
Place of Birth:
Armed Services:
Spouse's Name:
Industry/Business:
Residence:
Mother's Name:
Facility or Address:
January 21, 2011
St. George
84
Evanston, Wyoming
No
Health Care
Steorge, Utah
Mable Sparks
Dixie Regional Medical Center
‘.yl, &w- I7 1t I V_- U P
CERTIFICATE OF DEATH
State File Number: 2011000881
Dorothy Jean Davis
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Faility Type:
14:40
Washington
April 30, 1926
Female
Widowed
Nurse
Associate Degree
Wallace W White
Hospital Inpatient
INFORMANT INFORMATION
Name: Marlene D Niederhauser Relationship: Daughter
Mailing Address: 244 East San Rafael Place, St George, Utah 84790
DISPOSITION INFORMATION
Method of Disposition: Burial
Place of Disposition: Lindquist's Washington Heights Memorial Park, Ogden, Utah
Date of Disposition: January 29,,2011
FUNERAL HOME INFORMATION
Funeral Home: Metcalf Mortuary
Address: 288 West St George Blvd, StGeo Utah 84770
Funeral Director: Quinn`M Hadley
MEDICAL CERTIFICATION
Medical Professional: Robert Lemon MD,; East Center Street, #103, lvins, Utah 84738
Date Issued: January 27, 2011
l
Janice L. Houston, State Registrar
Office of Vital Statistics
CAUSE OF DEATH
Respiratory Failure
Due to (or as a consequence of): Pulmonary metastasis [Onset: 2 Days]
Due to (or as a consequence of): Anaplastic Thyroid Cancer [Onset: 2 Months].
Tobacco Use: Non- user
Medical Examiner Contacted: No Autopsy. Performed: NQ Manner of Death: Natural
11111 II 111 fi 1 I
000676
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 violet fibers and hologram image of the Utah State Seal, over the words "State of Utah This
document isplays the date, seal and signature of the State Registrar and the County /District Health Officer.
David W. Blodgett
Director /Health Officer
County /District Health Department
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.