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Home My WebLink About961516Affidavit of Successor Trustee I, Susan K. Johnson, being of lawful age and duly sworn according to law, upon my oath, depose and state: That under the date November 14, 2006, Charley R. Johnson, by deed of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk, on December 1, 2006, in Book 641 on Page 838, conveyed to Charley R. Johnson and Susan K. Johnson, as Co- Trustees of The C. R. Johnson Trust u/d/o July 14, 1998, as amended, the following described property situate in Lincoln County, Wyoming, to -wit: T24 R114 S11 Pt. Tract 44B 1.5 acres, further described as follows: Being a parcel of land situated in Tract 44B in Section 11, Township 24 North, Range 114 West of the 6 Principal Meridian, Lincoln County, Wyoming, more particularly described as follows: BEGINNING at the Northeast Corner of said Tract 44B and running thence South 80 feet; thence West at right angles 80 feet; thence North at right angles 80 feet; thence East at right angles 80 feet to the point or place of beginning That by reason of said conveyance aforesaid, Charley R. Johnson and Susan K. Johnson, as Co- Trustees of The C. R. Johnson Trust, became the owners of the above described land, and title thereto vested continuously in said co- trustees from the date of conveyance described in said deed to the date of death of Charley R. Johnson, on the 22nd day of November, 2010. That by reason of and upon the death of Charley R. Johnson, and pursuant to the Administrative Provisions of the Trust, title to the above described real property vested in Susan K. Johnson, Successor Trustee of The C. R. Johnson Trust u /d /o July 14, 1998, as amended. Affiant avers and certifies that Charley R. Johnson is the identical party named as co- trustee in the aforementioned deed, whose death terminated his interest, title and estate in said real property; and Affiant attaches hereto and makes a part of this affidavit, a copy of the Official Certificate of Death of said decedent, duly certified by the public authority in which said death certificate is a matter of record. Dated this rl day of 2011. State of NeVisOi;}) )ss. County of C' i; Susan K. Johnson Subscribed and sworn to before me, ,a notary public in and for said County and State, by Susan K. Johnson, this t 2 `'day of hK r 2011. WITNESS my hand and official seal. t!Zast�' My Commission Expires: RECEIVED 10/20/2011 at 2:41 PM RECEIVING 961516 BOOK: 774 PAGE: 782 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY This Document is beif►g recorded by Rocky Mountain. Title Insurance Agency of Lincoln County as a COURTESY only 77 ary Public NOTARY PUBLIC STATE OF NEVADA County of Clerk MATTHEW MURPHY No:06 103594 1 M �..intment Expires March 8, 2014 000782 This document has boon prepared as an aeoomodation by Rooky Mountain Title without the beMi t of a Title keno and its accuracy is not guaranteed STA IM DEPARTMIE TIj0 I �q 4l ESOURCE �I `IIIIIIII IIIIII IMI Q OF HEAL SI ICS II II III IlllP VIII IIpl� Ill�l,llll pI I lul CERTIFICATE OF DEATH 2010017509 p r STATE FILE NUMBER IIIII ffi A l EASED NAME (FI T S F DEATH (Mo /Day)Year) II rleY R S I 1 �lo 2- ATE O vember 22 20 arJ VIII I V ITY, TOWN, OR LOCA c. P L OR OTHER INSTITUTION Name(Ifrioieitherglve street 3e If Hosp. or Inst. in Icet D er m. SEX and number) Inpatient(Specify) DECEDENT Las Vegas 10025 Rolling Glen Ct Home Male 5. RACE White 6. Hispanic Origin? Specify 7a. AGE -Last 7b. UNDER 1 YEAR 7c. UNDER 1 DAY 8, DATE OF BIRTH (Mo /Day/Yr) (Specify) No -Non- Hispanic birthday (Years) MOS DAYS HOURS MINS 78 December 12,1931 Al 9a STATE OF BIRTH (If not U S A 9¢=- CITIZl1 T COUNTRY 10.EDUCATION 11 RI E �I RRIED, WIDOWED, 12 G S g ive OCCURRED IN name country) R1 W 01n U i eS t Il D l Wy g INSrrrunoN Y 1 �lJ l IIIIII II� II lul�lil led m FLAUB SEE HANDBOOK I II 13. SOCIAL SECURITY NUMB€RM 140 3S13W_ T ION (Give Kind of W V h i nn osii' III III III Armed ?REGARDING g f E rRetired) BUSIne$III I II V I III'll IIII Civil Engirt g III COMPLETION -OF IIII�I KIND OF BUSINESS Y IIIII Yes RESIDENCE 15a. RESIDENCE STATE 1 15b, COUNTY 15c. CITY, TOWN OR LOCATION 15d. STREET AND NUMBER 15e, INSIDE CITY ITEMS LIMITS (Specify Yes Nevada Clark Las Vegas 10025 Rolling Glen Ct orNO) Yes 16. FATHER NAME (First "Middle Last Suffix) 17. MOTHER NAME ;(First Middle Last Suffix) PARENTS h Oh I 'IIIIII IIIIII Ili II II Rose wSHRADER ��I II III II t I ORMANT- NAME I III (Street or R F� No City or Town State, ,I VIII nil Sus 0025 Rollin Glen Ct. Las Ve at asad 91 IIIIIIIIIIIII 19a. BURIAL, CREMATION, A R ify 9b. CEMETERY OR CREMATORY -NAME 19c. L01NON tbrTaWn State DISPOSITIO Burial Southern Nevada Veterans Memorial Cemetery Boulder City Nevada 89005 20a. FUNERAL DIRECTOR- SIGNATURE (Or Person Acting as Such) 20b. FUNERAL 20c, NAME AND ADDRESS OF FACILITY RICHARD C BOBO DIRECTOR LICENSE Bunkers Mortuary SIGNATU AU 69 ulhlll�ul i�25 N Las Vegas Blvd Las Ve as N TRADE CA LL TRADE CALL NAME AN DDRE F ]F?fl f I I F IIII III IIIIII ij n 21a, To the best of mMoe a de er t me, date and place �;j ,t� i dal !I het I f examination and/or in p rred at °m o due to the cause(s) sta5lgns SIGNATURE AUTHENTICA� i;D P Ile til�I,Ya III place and due to the s a l m °II CHRISTOPHER CHOI MD m'o CERTIFIER E n 21b. DATE SIGNED (Mo/Day/Yr)' 21c. HOUR OF DEATH E 0 22b. DATE SIGNED (Mo /Day/Yr) 22c. HOUR OF DEATH z' November 23,` 2010 10 :52 0 z o 21d. NAME OF ATTENDING PHYSICIAN IF OTHER THAN CERTIFIER o "0 22d. PRONOUNCED DEAD (Mo /Day/Yr) 22e. PRONOUNCED, DEAD AT (Hour) (Type or Print) o hull hi ll a I E AND ADDRES I I HIDING PHYSICIAN MEDICALEXAMINER; i1R RONER) (Type or Print) LMN tINSM VIII H "10105 BanburrKrossS as Vegas NV 89144 I REGISTRAR (Signature l I I T M kkRINGTON ?4b. DATE RECEIVED BY REGISTRAR 24c DDF OMMUNIC`ABLE ?DISEASE Mo/Day/Yr) SIGNATURE AUTHENTICATED November 23, 2010 YES NO Q CAUSE OF 25.;IMMEDIATE.CAUSE (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b), AND (c)) Interval between onset and death DEATH PARTI (a) Multiple myeloma DUE TO OR AS A C OblsEQ UE V.E aim III plq rval and death p I I p� t l m C A N Y WHICH i llll ll I III I I IIIIII IIII II it II ANY WHICH: dea o III GAVE RISE TO b). DUE TO, nRa t1NSEE r Q IIIIII Ills Int and th (C) .IP�IhIIIq IIII I� H IIIIIIII STATING THE DUE TO OR AS A CONSEQUENCE OF: UNDERLYING. Interval between onset and death CAUSE LAST (d) PART 11 OTHER SIGNIFICANT CONDITIONS Conditions contributing to death but not resulting in the underlying cause given in Part 1. t 27, WAS CASE REFERRED spectty Yes o No So cO o ER �saY Yes HOM U E a 2ec HOUR OF INJU 26d H INJURY OCCURRED T. (Specify) 28e, INJURY AT WORK (Spe 8f. OF INJURY -At home, farm, street, factory-office 28g. LOCATION STREET OR R.F.D. No- CII Y_' TOWN STATE Yes or No) building, etc. (Specify) w STATE REGISTRAR I I Illlull IIIIII If I I (IIII I IIIL�II III I I ,I� q I II I Iq,lll�llllllll I illlll I VIII "CERTIFIED TO BE A TRUEAND CORRECT COPY OF THE DOCUMENT ONFILE WITH.THE REGISTRAR OF VITAL sTATIsTI c L2 0 10 0216 STATE OFNEVADA. °':This copy was issued by the, Southern Nevada Health District from State certified documents as authorized by the State B oard of Health pursuan O 11 lidlV IIII !II I;I (II IIIIIIIIi (IIII vIIlI DIIIIiii'i II LawrenceI )I II NOT VALID WIT I II III� �IIi II Illllullull Registrar of Vitt tt IIII IIIIII SEAL OF THE SOU2`HERNNEVADA By: HEALTH DISTRICT Date Issued: DEC 2 0 2 Q10 I pllll!I Iplllll IIIIII III III l .N jl pill II I (IIIIII g llu� i� iI O IFIERN NEVAD, �I$ Ilp pA� �dow Lane P O Sox 394? as e as Nevada89127 702 759 W DM lM IJU II� VI IIIIIUIVIfIIIIVV IIII CCIIII