HomeMy WebLinkAbout877444 Affidavit Affecting Title
I, Douglas T. Clawson, being duly sworn on oath depose and state
as follows:
1. That on January 30, 1992, Ruby C. Clawson, executed a deed
in favor of Ruby C. Clawson, Trustee of the RUBY C. CLAWSON
LIVING TRUST, dated January 30, 1992, said deed being recorded
March 9, 1992, in Book 307PR, page 514.
2. That the following described property was listed on the
aforementioned:
Lot Forty-Three (43), in Star Valley Ranch Plat Two (2)
as platted and recorded in the official records of Lincoln
County, Wyoming
3 ~ That Trustees under said Trust were RUBY C. CLAWSON and
DOUGLAS T CLAWSON, as set forth as number 2 on Certificate of
Revocable Living Trust, and a copy is attached hereto as Exhibit
4. That upon the death or incapacity of RUBY C. CLAWSON,
DOUGLAS T. CLAWSON shall ~serve as the sole trustee, as set forth
as number 3 on Certificate of Revocable Living Trust, and a
copy is attached hereto as Exhibit "A".
5. That RUBY C. CLAWSON died on the 11th day of November,
1994, and a copy of the Death Certificate is attached hereto
and by this reference incorporated herein.
6. That DOUGLAS T. CLAWSON signed, a Certificate of Incumbency
as Surviving Trustee on January 5, 1995, and a copy"is attached
hereto as Exhibit 'iB".
Douglas T. ~lawSon
State of Nevada )
) ss.
County of Clark )
The foregoing instrument was acknowledged before me, a notary
public in and for said County and State, by Douglas T. Clawson,
Surviving Trustee of THE RUBY C. CLAWSON LIVING TRUST dated
the 30th day of January, 1992, this~'.Z~.day of ~t-~_~..~.~-.,
2001 .
WITNESS my hand and official seal.
~ %~~n~v or C~k ~ i~otary, PubYic ' ' '
~ ~ JOAN B, BROKER ~ ' '
o: 7-02 6-1
My Commission Expires: l~'3
Exhibit "A"
CERTI~CATE OF REVOC~LE LI~NG TRU~
Contemporaneously with the execution of this Certificate, the undersigne~q, RUBY
CLAWSON~ t resident of Oark County, Nevada, has execuied mat certain ~.ument entitled,
the "RUBY C. CLAWS.ON LIVING ~'~ l~ .
IRt ST dated ]~uaW 30, 1992, which provi0es in
~nent p~ as follows:
GR~NTOR: The Or~tor under me ~erms of s~d Trust is RUBY C
CLAWSON,
2. ~.t STEES: The' Trusts under ~d Trust ~e RUBY C, CI.AWSON and
DOUG'LAS. T, CLAWSON. '
3. SUCCEssoR ~USTEE: U~n the fl~ or inmpaci~ of RUBY C.
CLAWSON, DOUGLAS T~ CLAWSON 'sh~l ~e~e as the sole Trustee
here'under.
4. BE~c~I~S: The benefici~es of ~is Trust ~, the ~lmstor and
~CA~ACE S. GANs, DOUGLAS T. CLAWSON, m~d STAnlEY D.
CLAWSON.
5. ~W~ TO A~ OR REVel: Duhng the life of the Grantor,. the
may b~ revoked in whole or in pan b7 ~} instm~nent in writing sign~ by the
O~tor ~d detiver~ to the Tmst~. The Orm~mr may, at ~y time during the
O~tor's life., amend ~y of the terms of the Tm~t by ~ ir~atmment
sign~ by the G~tor ~d ddiver~ to the Tmst~.
6, ~WER TO ..iCT A~N~: Pro~ of the Trust may be i~eld, retmn~ or
m~ag~ by any one of the Trust.s acting flone without ob~ning ~rmission
from the other ofiginM Trustee.
7. ~W~S OF TRUSTEE:
(a) To register ~y s~Uhfies or other prope~y held hereunder in the
name of Trustee or in the name of a nomin~, with or without the
addition of words indicating that such s~uh~es or other prope~y
~e held in a fiduci~y ca. city, ~d to hold in b~er form any
~ec.uhfies or o~er pro~.rty held hereunder so thai title ~ereto will
pass by deliver7, but the b~ks ~d r~rds of Trust~ 'shall show
that ~t such investments are pan of her res~ve fund.~
, b) To hold, manage, invest ~d account for the separate Trusts in one
or more consolidated funds, in whole or in pa~. as she
Oete.mme, As to each consolidat~ fund, ~e division into the
vmou~ ,h~s comprising auch fund ne~'~ ~e made only
Tmst~', books of a~otmt,
IN. WI ~ N?~$ '
WHEI~,OF, thc Grantor has hereunto set her ll~d
RUBY C.
STATE OE N:~VADA )
)
COUNTY OF ZLARK )
C}~ Jin a~ 30, 1992 befor~ me, th~ md~rsigae~, a No~'y Pubhc in ~d for
m~d S~te, ~rt:.:m~ly aP~ RUBY C. ( ,AWSON, ~own ~o
, in m~d who ex~ cutefl the foregoing Ce~fic: : of Re:v~bte Tm~t, and duly
' that tE~ C~>ica~ was ex~ut~ ft~ly ~ 01un~nly ~d for the u~s ~d pu~ses therein.
mm0,on~. ' ·
WiTNI tSS my hand and official se;.: .
q ~>, NOTARY PUBUC
Jolm E. Dawson I ~
g~o~,Y FOR GIL&~OR j
Al;Omcy~ W.
i[~li,~,,~ ~ ):~:~.,,~ STATE OF NEVADA -- DEPARTMENT OF HUMAN RESOURCES
r--- DIVISION OF HEALTH -- SECTION OF VITAL STAT STICS ,~ ~ ~ '~/
TYPE / DECEASED--NAME Firsl Middle Last I DATE OF DEATH (Month, Day, Year) I COUNTY OF DEATH
OR PRINT STATE FILE NUMBER
PERMANENT ~ at erzne CLAWSON 2 November 11, 1994 3~ Clark
zz ~ ,~ ur u~A'/}~-~ ~HOSP TAL OR OTHER INSTITUTION Name ff not e~ h r " '
BLACK INK tTY. TO OCAT 0'' ~ ...... I '
' -- ( 't e. give street and number) I If Hosp. or Inst. indic~!~ DOA OP/Emer I SEX
-- -- I Rm. inpatient (Specily)
3b. LaS Vegas 1Jo, Life Care Center of Las Vegas 13e. Inpatient 4 Femal-
e. White y ........ tO R ...... lc. Brrthday(~Ye~ars) MOS , DAYS I HOURS o MINs I
6.
I~a' ~ 17b, [~, [~, January 6, 1926
STATE OF BIRTH cFr]ZEN OF WHAT DOUNTRY Decedent's Education Specify highest MARRIED, NEVER MARRIED, SURVIVING SPOUSE (If wife, g~ve ma~den
IF D(ATH (If not U,S,A., name coucqry) grade completed. WIDOWED, DIVORCED
REGABOIN8 SOCIAL SECURITY NUMBER USUAL OCCUPAT!ON (Give Kind el Work Done During Most ef I KIND OF BUSINESS OR INDUSTRY
COMPLETION OF Working Lile. Even it Relired)
*~S~OE,Cf~T~VS ts. 315-20-6667 t4a. Secretary / Retired It4b' Ned±ca1
I RESiDENCE--STATE COUNTY CITY, TOWN. OR LOCATION STREET AND NUMBER INSIDE CITY LIMITS
' [-~ 5a Nevada ~5~ Clark ~e" Las" 4613 Hayes I¢~p,~y~ ....
'>, ~ I ' · · ~egas J~d. Place t~e. Yes
FATHER--NAME First Middle Last [ MOTHER--MA/DEN NAME Flrsl Middle Lest
~ to. John Gard It~, Florence Stewart
INFORMANT--NAME (Type or Pa'at) I MAILING ADDRESS (Street or R,F,D bio., Cily or Town, S~ate, Zip)
J~e, Candy Gaas - Daughter IteL. 7916 Martingale Lane Las Vegas Nevada 89123
, ~se. Crem ion ~ Palm 1
, ,, ,~ - ~ ' Creaatory ' Las
Z 2tn. lo he ees o my k cwledge, de rte t imed . ,, , q , Nevada 8912;3
< due o he cause(s stated "" , a nd lace nd 22a. On the,barns o~ examination and/or ~r~vestJgahon n ny opinion dea h occurred
~ S/Er,a/ ..... dT/":,~jl~' ~/~'~D'~/ ~. at the tHt~e, date andplace and due to Ih ...... (si and ....... ,ned.
_~*r DATE S GNED fo a r ~ 0 OF B ~ '~' ¢~="
¢, ,,~Ds~ Xr.J, //)~'2X 1~ ' ~ ~0 DATESlGNED(Mo., Day, Yr.) HOUROFDEATH
~ .~ ~_ NAME OF A"FrENDING PHYSICIAN IF OTHER THAN CERTIFIER T e or Prml ~ ~5
~-~ ( YP ' ) ¢0 PRONOUNCED DEAD (Mo., Day, Yr.)PRONOUNCED DEAD (Hour)
0 2rd. 22d. ON 22s. AT
'"r 23a. Hark 8urroff~ D.O, 2010 Co]dr~ng Avenue Las Vegas Nevada 89106 q 23b~J~'/'
WHft~}~NGYAvECONDITIONS f24a.(S/gnature)~ REGISTRAR ( /'~/// _.1 /~ ~ ~ ~,-- ~ .~ / ~) I DATE/RECEI~F~D BY REGISTRAR (Mc., Day. Yr.) DEATH DUE TO COMMUNICABLE BISEASE
r-'~ ~, ~MMEDI^T~ CAUSE.._/' /ENrER ON~ r ONE CAUSE S#P~/~
CAUSE ' '-.. ' ° Inlerval between onsel and death
CAUSE LAST J I DUE ~Oi ~ AS / CONSEQUENCE OF: t ' --'
t [ DUE TO. OR AS A ~ONSEQUENOE OF: I[ ! ' interval between onse, and death
PART OTHER StGNIDCANT CONDITIONS--CondRions contributing to death but nol resulting in the underlying cause given in Pad I. AUTOPSY (Specify WAS CASE REFERRED TO
l or No)
II Yes or No) CORONER (Specify Yes
2e. Nn 27. Ntt
ACC,, SUICIDE, HOE,, UNDET,, DA~OP~NJURY~m.,O~, YO HOUR OF INUURY DESCRIBE HOW INJURY OCCURRED
OR PENDING INVES~.
28a. 28~, , 28c. M 28d.
iNJURY AT WORK PLACE OF iNJURY--At home~ farm, street, lactery, office LOCATION. SIREET DR R,F.D. No. CITY OR TOWN SLATE
(~pecify Yes o~ No) b~ilding, elc. (Specify)
STATE REGISTRAR
"CERTIFIED TO BE'A TR UEAND CORRECT COP Y OF THE DOCUMENT ON FILE WITH TIlE REGISTRAR OF
VITAL STATISTICS, STATE OFNEVADA." This copy was issued 'by the Clark County Health District from State
certified documents as authorized by the State Board of Health pursuant to NRS 440.175.
NOT VALID WITHOUT THE o'r'ro t^v N/<our, t.u.
RAISED .. EAL OF THE CLARK of Vital Statistics
COUNTY. ,.i,:, EALTH DISTRICT
:, ,., ~,,.< '[' ! r" .:;'
.,,
....·, .,. ".....'"'. ':'.'"": CLARK COUNTY. HEALTH DISTRICT
625 Shadow Lane P.O. Box 4426
· Las Vegas, Nevada 89127
702-383-1223
STATE OF NEVADA ) 3 ~J ,~
) ss,
COUNTY OF CLARK )
DOUGLAS T. CLAW:SON, being fn'st duly sworn, deposes and says as follows:
1, That RUBY C, CLAWSON created THE RUBY C. CI_,AWSON LIVING
TRUST on the 30th day of Sanuary, 1992, wherein ~he was designat~ 0R of the original
Trtlgt~¢~. · ~'
2. That RUBY C. CLAWSON died on the 11th day of November, 1994, and a
certified copy (~f the Death Certificate is atuched hereto and by this reference inc. orpota~ed
herein.
3. Tha~ DOUGLAS T. CLAWSON i$ named, in said Trust as the Survivi~g
Trustee and hereby fries this Ce. rtificate and accepts the Trusteeship of THE RUBY C.
CLAWSON LIVING TRUST dated thc 30th day of January, 1992.
DATED this _~l?day of lanuary, 1995~
DOUO~$ T. CLAW$ON
STATE OF NEVADA ) · . ,~ ~,,~ .....
COUNTY OF C~ )
On ~s ~ day of Janus, 1995, personally ap~a~d bcfi)rc rn~, a No~
~blic, DOUGHS T. C~WSON, who ac~o'wledged to me ~at l~e executed lhe above
immtm~nt as ~e Su~iv~g Tmgtee of lttE RUBY C. CI~WgON LI~NO ~UST dated ~e
3~ day of Janus, 1992,
tNo~ ~blic -
WHEN RECORDED, MAlL TO:
DOUGLAS T. CLAWSON
8809 Bologna Drive
Las Vegas, Nevada 89117