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Home My WebLink About964076Joyce B. Barrus, being first duly sworn upon my oath deposes, and states as follows: 1. That I am a successor trustee of the Grant M. Barrus and Joyce B. Barrus Revocable Trust dated Mater 20, 1986 2. That on March 21, 1986 in Book 236PR on page 685 of the records of the Lincoln County Clerk was recorded a Quitclaim Deed from Grant M. Barrus and Joyce B. Barrus to The Grant M. Barrus and Joyce B. Barrus Revocable Living Trust conveying the following described land: The NE1/4SW1/4 of Section 15, T32N R119W of the 6 P.M. Lincoln County, Wyoming. 3. The Quitclaim Deed conveying the property to the trust was not properly defined as required by Wyoming State Statute 23 -2 -122 in that the date to the trust was not shown. The date of the trust is March 20, 1986 4. The Quitclaim Deed conveying the property to the trust was not properly defined as required by Wyoming State Statute 23 -2 -122 in that the trustees of the trust were not named. The Trustees are Grant M. Barrus and Joyce B. Barrus. 5. That Grant M. Barrus died on May 9, 2000 as shown on the certified copy of the decedent's death certificate attached to this Affidavit and, pursuant to the provisions of said Trust, Joyce B. Barrus is the successor Trustees. State of Utah County of Salt Lake )ss AFFIDAVIT I, Joyce B. Barrus, do solemnly swear that I have read the foregoing Affidavit subscribed by me; that I know the contents thereof and verify believe the statements therein contained are true. Joyce B. Barrus 01)586 Joyce B. Barrus RECEIVED 4/12/2012 at 12:42 PM RECEIVING 964076 BOOK: 784 PAGE: 586 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY The forgoing instrument was subscribed and sworn to (or affirmed) before me this day of 291137 Joyce B. Barrus. Witness my hand and official seal. 4 My commission Expires: F 00587 ,EAN HERRETf ALEXANDER 609783 (;OMMISSION EX[ IRE'S MAY 19, 2015 NOTARY PUBLIC. STATE OF UTAH TYPE OR PRINT IN P50 1311 07 BLACK INK FOR INSTRUCTIONS SEE HANDBOOK DECEDENT PARENTS INr0)t MA NT VR 2 -89 8/97 15M CERTIFIER CAIJSL OF 11f 1110 4. SOCIAL SECURITY NUMBER 7s. PLACE OF DEATH (Check Dory one) 7b. FACIUTY NAME (If ncl Mdmnbr4 phi street and number) STAR VALLEY MEDICAL CENTER 6. STATE OF BIRTH (U gat h •USA., n.ne couXry) WYOMING 11. MS DECEDENT EVER IN U,S. ARMED FORCES (Smelly yes or no) 13a. RESIDENCE STATE 13e. 1NS10E 0111 1.111413 f (Specify yea or no) NO 0010. INFORMANT -NAME mpp re Rica) JERRY BARRUS;. 100. RASING ADORE88 STREET OR RFD NUMBER 3975 BITTERCREEK ROAD 20a. Buret Crem.11on, Removal 20b. DATE (MO.. Day, N.) from Se )9Wdfy) RIAL MAY' 13, 2000, 2 FU UCENSEE�Or Person Mang Number Such 6a. REGISTRAR 158532 LOCAL FILE NUMBER DECEDENT -NAME FIRST =Inpatient' ER f Outpollent DOA WYOMING 17. FATHER'S NAME ",FIN ALBERT 22d. NAME TTENDING IMMEDIATE CAUSE (Final climate ce condition muffing In death) .1 STATE OF WYOMING 13b. COUNTY GRANT MILLWARD Z sr to and Me) l a1Mad, r (Spasms. od TAN 221. DATE SIGNED .:1AM... Ig /410 DEPARTMENT OF HEALTH STATE OF WYOMING DEPARTMENT OF HEALTH CERTIFICATE OF DEATH 5. AGE -Iaat Skalds. friars) Nursing Home Resioarce Other (Specify) FARMER 13c. CITY, TOWN OR LOCATION LINCOLN AFTON 14. 111118 DECe1ENT OF hISPANI0 ORIGIN? ISpeo8Y nor yes U ysa, specify Cuban, Mexican, Reno Rican, Etc.) NeLJ Yes 0 (Specify) BARRUS Months Days 20c: CEMETERY OR CREMATORY NAME FAIRVIEW CEMETERY 1b. NAME OF FACILITY SCHWAB MORTUARY 24. NAME AND ADDRESS OF CERTIFIER (PHYSICIAN OR CORONER)(Type .r hex) 0. D. PERKES MD. 110 HOSPITAL LANE AFTON PART I. Enke the deseeal, IrAdac or co pYWbm that caused (Meth. Do not enter the mods of Mina, such 00 surd 28. 011 mpl 0(00? .1101(. .Muck, or heart failure. UN only ore caws on .0111 one. DUE TO (OR *531 C008EOUE 05) b. r- ii r Sapaen 3( let .0.408 are, 011E TO TOR AS A CONSEOUENCE 051: 8 T e ry, .drp to Immediate Tara.. Enter UNDERLYING aa CAUSE (Mae r Inlury DUE TO (OR AS A CONSEQUENCE OF): dial Initiated emits 10suMn0 in death) LAST d. MIT U: pgiER SIGNIFICANT CONDITIONS Conditions 30a. DATE OF INJURY 301. TIME OF (Moan, Dry, Yee) INJURY This is a true and exact reproduction of the document on file in the office of Vital Records Services, Cheyenne, Wyoming. DATE ISSUED: BARRUS 6b. UNDER 1 YEAR CITY OR TOWN AFTON 30c. INJURY AT WORK? (Specify Ms or no) 2. SEX MALE 5c. UN R1DAY 7c. CITY, TOWN, OR LOCATION OF DEATH AFTON 10. SURVIVING SPOUSE. IN MN, 11310 maiden JOYCE FERN BROWN' IS. MOTHER'S NAME Fhl ALICE STATE WYOMING 1111. RELATIONSHIP TO DECEDENT SO N 23d. PRONOUNCED DEAD (Aso,. ;Day, (7) STATE FILE NUMBER 3. DATE OF DEATH (MO., Ory, (7) MAY 9, 2000 126. KIN) OF BUSINESS OR INDUSTRY AGRICULTURE 13d. STREET AND NUMBER 6112 BITTERCREEK ROAD Black, WNI1, Esc. (S4.cib) WHITE WYOMING 83110 7d. COUNTY OF DEATH LINCOLN 06. o..cceNta 1100040.4 (9,0007 dray how prod. CO501Na) Elrnanery /S.c. d.ry (0.12) Coe°. (1 -4 or 5 1' Madan Surname MILLWARD 20d LOCATION i� CRY 001031N STATE FAIRVI WYOKIN Number 210. ADDRESS OF FACILITY 45' 44 EAST 'FOURTH AVE., AFTON 23c. HOUR OF DEATH 261. DATE RECEIVED BY REGISTRAR (Ma, Day, 27. AUTOPSY (Speelly 26. WAS CE REFERRED TO CORONER yet r 4e) (SpacVy AS yp r oo) NO NO 30d, DESCRIBE HOW INJURY OCCURRED 301. LOCATION (Street and Number or Rur. Route Number. City r Town.:Staid' Lucinda Mff� Deputy State Registrar This copy is not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar.