HomeMy WebLinkAbout963911RECORDING REQUESTED BY AND TO BE RETURNED AFTER
RECORDING TO:
SCOTT EDWARD DARLING
3697 ARLINGTON AVI :NUE
R1vERSIDf., CA 92506 -3938
0 0 0 8 1
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RECEIVED 4/2/2012 at 2:57 PM
RECEIVING 963911
BOOK: 784 PAGE: 81
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
(Space above this line for recorders use)
MAIL LEGAL NOTICES AND TAX STATEMENTS TO:
Mail Tax Statements and
Legal Notices to Owners address at
bottom of this page.
Documentary Transfer Tax NONE
No consideration
conveyed, or
the rantor's
tax: The undersigned
for transfer
X
City of or Unincorporated Area
Computed on: X Full value of property
Reason for exemption: Conveyance transfers
Signature of declarant or agent determining
Computed on full value less liens encumbrances remaining thereon at time of sale.
into •rantor's revocable living trust. Rev. Tax. Code 11930
interest
Firm name: Scott Edward Darling
AFFIDAVIT OF DEATH TRA#
THE UNDERSIGNED, BEING OF LEGAL AGE, BEING FIRST DULY SWORN, DEPOSES AND
DECLARES AS FOLLOWS:
APN
NAME OF DECEDENT ON DEATH CERTIFICATE:
David Paul Thirion
NAME OF DECEDENT ON DOCUMENT:
David Thirion
THE DECEDENT MENTIONED IN THE ATTACHED CERTIFIED COPY OF CERTIFICATE OF DEATH IS THE SAME PERSON AS THE PERSON
WHO IS NAMED AS ONE OF THE PARTIES IN THAT CERTAIN DOCUMENT DESCRIBED AS FOLLOWS:
TYPE OF DOCUMENT:
Quitclaim Deed
EXECUTED BY:
David Thirion and Linda Thirion, husband and wife as tenants by the entireties
with right of survivorship
GRANTEE(S):
Family Trust of David P. Thirion and Linda L. Thirion
DATE RECORDED:
2/24/12
IN BOOK
7 8 1
INSTRUMENT
963359
PAGE
708
COUNTY RECORDED IN:
Lincoln
STATE OF:
Wyoming
CONCERNING THE REAL PROPERTY SITUATED AS FOLLOWS:
CITY OF:
COUNTY OF: Lincoln STATE OF: Wyoming
SAID REAL PROPERTY IS DESCRIBED AS FOLLOWS:
See attached legal description
1 CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT
AND IF CALLED TO TESTIFY THERETO THAT I COULD AND WOULD SO COMPETENTLY TESTIFY THERETO:
Place of Execution:
Riverside, CA
Certificate Of Acknowledgment Of Notary Public
State of California,
County of: Riverside
On MAR 2 F0 ?01?
a Notary Public in and for said State, personally appeared:
Linda L. Thirion
person(s) acted, executed t
I certif TY O
for eoinct paraprarr s tr
w
Signa
NOTARY PUBLIC
M rio,u,a•znim i,nilmtl c
DattiAR `(r 0 2012
before me
SS
Affianl Signature:
NAME:
Who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
he /she /they
executed the same in his /her /their authorized capacity(ies), and that by his /her /their SEAL:
signature(s) on the instrument the p rson(s), or the entity upon behalf of which the
instr ent.
Y under the laws of the State of California that the
Linda L. Thirion
Benilda Duke
is /are subscribed to the within instrument, and acknowledged to me that
''.n" maw: s4�eA 'i3eiLre9r6S&£ra {iu,_.i( ^,uav, zk4rwAtr .ut�,.mB:,:sS%e.s+.;.
BENILDA DUKE
Commission 1839377
Notary Public California n
Riverside County
My Comm. Expires Mar 5, 2013
Mail Tax and
Legal Notices to:
Ms. LindaThition, 19221 Maywood St., Bloomington, CA 92316
Legal description:
Township 22 North, Range 115 West, 6th P.M.
Section 12: SE /4 NE 1 /4
Township 23 North, Range 112 West, 6th P.M.
Section 7: N1/2,SE1/4 SE1/4SE1/4, Lot 11
Section 8: SW1/4SW1/4
Section 17: NE' /4, N1/2NW SE'4NW1/4
Township 23
Section 10:
Section 11:
Section 12:
Section 14:
Tract 38
Section 19:
Section 17:
Section 19:
Section 20:
Township 23 North, Range 114 West. 6th P.M.
Section 24: E'fSE1/4, SW' %SE' /4, SE's SW' /4 described in Resurvey as
Lot 37
Township 23 North. Range 115 West, 6th P.M.
Section 13: SW' /4NW'/4
Section 15: NE'4NW'4
SW' /4
NE'/4NE' /4
W'/i, E' NE' /4
SE'44SE' /4
S' .SW V4 SE'/4SE1/4, SE'4SE' /4
S'f SW1/4 SW1/4 SEW N'SW' /a SE' %NW' /4, SW1/4,SE1/4
Section 20:
Section 27:
Section 29:
Section 33:
Section 34:
Section 35:
North, Range 113 West, 6th P.M.
N1/2NEV4, SE' /4NE' /a, NE' /4NW'/4 described in Resurvey as
Lot 37
N1/2.SE1/4, N' SW'/4 described in Resurvey as Lot 41
SW'/4SW'/4, Lot 11
Lot 3, W1/2NE1/4, SE1/4NW1/4 NEW SW1/4
N' SW' /4, SE'/4NW1/4, SW1/4NE described in Resurvey as
Lot 40
SW' /4SW%
NE' /4NE' /4
NW1/4NW1/4 described in Resurvey as Lot 39
Township 24 North, Range 114 West 6th P.M.
Section 28: NE1/4SW1/4, N1/2,SE' /4, NW1/4SW /4
Section 29: N1/2SE1/4, NE1/4SW1/4, NW /4
Section 30: N1/2.SE1/4, NE'/SWV, Lot 7
Township 24 North, Rance 115 West, 6th P.M.
Section 25: N1/2SE /4
00082
5
..OREGON'
L.
o
1E,
'20.
1. NAME OF DECEDENT -FIRST (Given)
:DAVID
•••^•r
2. MIDDLE
PAUL
LwAL emcee Rath ioN NUMBER
3. LAST (Fateily),
THIRION
AKA, ALSO KNOWN AS I' 1 d 1 KA (FIRST, MIDOS
..IIA. MIDDLE.. LAST)
DATE OF BIRTH mm /22 /ccyy
4. .I p A
01 /18/1944
5. AGE Yrs. 1 I U ND ER ONE YEAR
IF UNOFn 21 HOURS
6. SEX
•rM
1 (2 2 4
68 Months D y
Hour Minutes
S. BIRTH STAIE/FOREIGN COUNT O. S
RY I tOCIAL SECURITY NUMBER
.11. EVER IN U.S. ARMED FORCES?
ES
X .YES UM<
12 MARITAL STATUS/S R3P (alllma oIDeo1
MARR1:ED
TDATEOF ry DEATH mm /dd /c
02/13/2012
A HOUR Hours)
13. EDUCATION Highest LeveOOegne
(see worksheet on bock)
DOCTORATE
14/15. WAS DECEDENT HISPANICAATINO (AVSPANISH ?(Il yes 6e6Orkshe0 on
D YES
NO
16 :DECEDENT'S RACE- Up l53 r ace y0 listed( A kbeet :on;back)'
CAUCASIAN
1 7 USUAL,OCCUPATION Type,o work I osI of Ills. DO NOT USE RETIRED
.'ACCOUNTANT
DECEDENT'S RESIDENCE (Streel'end rime• in.,IU:1
18. KIND OF BUSINESS OR
ACCOUNTING
NDUSTRY (e.g.. grocery stare. road cbnstructon, employment agency etc)
15. YEARSiNTOCCUPATION
24
N
a
21 CITY
2 x.G0UNTY /PROVINCE 23. ZIP CODE
BLOOMINGTON SAN BERNARDINO 92316
.24: YEARS IN COUNTY
37
IG
25. STATE/FOREIGN COUNTRY
CA
th
26, INFORMANT'S NAME RELATIONSHIP
LINDA THIRION:WIFE
27. INFORMANT'S MAIUNG ADDRESS (SI 0e1 and number or rural rome number 1 1 ,slat and zip)
19221 MAYWOOD ST, BLOOMINGTON, CA 92316
Z
a2. LINDA
5 i
w
a
26. NAME.OF SURVIVING SPOUSE /SROP'- FIRST
29 MIDDLE
LEA
:39 LAST IBRRTH NAME(.
DELLERBA
31. NAME OF FATHER /PARENT -FIRST
PAUL
32 MIDDLE
EUGENE
LAST
33 LAST
34: BIRTH STATE:
IL.
NAME OF MOTHER/PA
35 RENT -FIRST
FAY
39: DISPOSITION DATE' H ;to et PL ACE DF FINAL DISPOSITION
36. MIDDLE
ESTELLE
37.,L'AST (BIRTH NAME)
FLETCHER
3 BIRTH STATE
WI',
N
a
L. U
°;'ARLINGTON.MORTUARY
41; TYPE 0 20APOSITON(S).:
B' V
:42: SIGNATUREOF EMBALMER:
NOT.EMBALMED
43, LICENSE NUMBER:
44. NAME OF FUNERAL ESTABLISHMENT
45, LICENSENUMBER
FD1033
SIATURE OP LOCAL'6EGISTR35
46 GN
CAMERON'KAISER, MD;
4t DATE mm %dd /ccyy
201?
`o z
U: 6'
•n.•
101. PLACE OF DEATH
COMMUNITY CARE AND REHABILITATIC}N CENTER
102. IF HOSPITAL, SPECIFY ONE
I P ER/OP DOA
103. IF OTHER THAN HOSPITAL, SPECIFY ONE
Hospice Decedent's
X
�TC e aver
.104, COUNTY
RIVE
105 FACIUTRADDRESS LOCATION WHERE FOUND (Street apt] number, or locales)
4070J.URUPA:A
RIVERSI
DE IDE
0
u'
0
in
107. CAUSE OF DEATH E 0 h 1 1 ds ea N pl 1518 Ih01Uu.IN caused de D0 NOT edler terirenal vents nick
as cardiac arrest, r pretory arrest, o irtcular 10.1 /4 610 sltpeang Ise etiology DO NOT ABBREVIATE.
IM w
MEDIATE CAUSE METASTATIC TRANSITIONAL
I B
Be M 100 0
tee/ anti Oeat1.
LAT
101 HFEFCREOTOCC 1.
YES
L1
CELL CARCINOMA OF THE RENAL. IAD.
d
14
mD 'amlmg PELVLS MTHS
i :death(.
(131
(B1)
Sgquen11411y Fist
d nesions Ir any,
108. BIOPSY PERFORMED?
C7 YES N O
eri Enter
(C1)
RLY
UNNDERLY ING
GAVSE (dlsoase 0 r
Inju that
OPS
116. ALITY:PERF.ORMED7
a YY4' X N
initiated the events ITN
res Ilan d ath LAST (DT(
u 9 1..
1 i1'.USEOINDETERMINING CAUSE
❑YE.. :ONO::
112.07025 SIGNIFICANT CONDITIONS CONTRIBUTING :TO DEATH NOT'RESULTING IN THE UNDERLYING CAUSE GIVEN 1N 107
CHRONIC OB PULMO AR
'113
:WAS DPEAATION•PERFORMED.FOR ANY/CONDITION IN REM 10700.1127 (II yes, listlyp r p lion anddate;(:
N
1134IF FFEGNANTIN IASTyEoR7
w Z
a Q
U
114. ICQ1BFYTH8TTOTLEBE $TCFM1I00Atl�C£CEVTMa
ATT6EFCUR 0 STATED.
•O DBCedoMAn DeedeM adSeanA
115. SIGNATURE F
URE ANDTITLE'CERTIFIER
F
/VICTORI S R A I NS M:1) v04:?.."
1 18:
116. LICENSE NUMDER
G50812
117 DATE to /d8 /ccyy
02/14/' :2
3
(A)' m /dd /cc)(y (B) mm /dd /ccyy.
01/31/20.12 921.12/2012-::...
118. TYPE ATTENDING PHYSICIAN'S NAME. MAILING ADDRESS. ZIP CODE
VICTORIA SHA RAIN'S "M.D
30524' LOS ALTOS, REDLANDS, CA.92373
j
O
O
i
0.
0
0
I CERTIFY TFW O +IM
TINMYO
0 ATTIENCIIFy
MANNER Of' b/ATH Nald Fil' E] Acc
DATE AhOPIOLESTAIDORCAIT5E ,CAUSESSTAIEO:
HOINCide O';Seidde O I O 0 d 1 64
120'INJUREDAT WORK?
YES NO a USA
121,.) DATE mm /42 /cyy
122. HOUR (24 Hours)
123. PLACE OF INJURY (e.g., home construction site, wopdee area, etc)
124. DESCRIBE HOW INJURY OCCURRED (EvpOis which resulted in injury)
125.LOCAT(O,N AF INJURY(SI 1 Rd'nu ba )cation and city, and zip)'
128. SIGNATURE OFDORONER /;DEPUTY' CORONER
127. DATE' mm/dd /dcyy
128. TYPE NAME, TITLE OF CORONER DEPUTY CORONER
STATE A
:REGIS'taAR
B
C
D
E
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REGISTRAFI
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STATISTICS
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19 221 MAYWODb :ST
02/287201'
30520
Iv:v 1,J[IJ1[OA PI•OCI)il „`I
COUNTY OF RIVERSIDE
STATE FILE NUMBER
.RIVERSIDE, :CALIFORNIA
CERTIFICATE OF DEATH'
STATE OFCALIPoRMA
552 BLACKINKONLY ND ERASLBES,WIBTEOUIS OR ALTERASONS
RIVERSIDE NATI ONAL:CEEMTERY
22495.> VAN .BUREN BLVR,:RIVERSID CA 92518
CERTIFIED::COPY OF ViTAL
:STATE OF CALIFORNIA,
COUNTY OF RIVERSIDE SS
This is a true and exact reproduction of th
;3
Ii 111 III III 11 IIII 1
an
De p arI o in the office of the County of Riverside, 6'
Department of keal
:Feb' y ?(.112
'1 eb a:,
Eric Frykman, M.D,,: LOCa) Registrar
DATE ISSUED RIVERSIDE COUNTY, CALIFORNIA
This copy not.valid unless prepared on engraved :border displaying; seal :and signature of Registrar
PBNCO (Ke 04/11
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