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That by the terms of the trust, Ricky Edward McCaslin and Kelly Patricia Murphy are declared and appointed successor trustees. 6. FURTHER, Affiant saith not. DATED this day of June, 2000. STATE OF WYOMING ]SS COUNTY OF LINCOLN 1 On thi$ day of June, 2000, Ricky Edward McCaslin did personally appear before me, a Notary Public in and for the State and County above mentioned, and acknowledged the foregoing AFFIDAVIT before me. WITNESS my hand and official seal. My Commission Expires: AFFIDAVIT McCASLIN Page 2 of 2 738 RICKY EDWARD McCASLIN NOTARY PUBLI DECEDENT 1. NAME OF DECEDENT FIRST MIDDLE '',1:AST GEORGE EDWARb ,MCCASLIN 2. SEX Male 3e. DATE OF DEATH (Mo., Day, Yr.) June 9, 2000 3b. TIME OF DEATH (24 hr. clock) 4. DATE OF BIRTH (Mo., Day Yr.) October 7, 1934 8a PLACE jHOiPITAL woos cross tor timpttel OF DEATH r (check only I I.A1 one) 1 IIII 2. ER/Outpettent 03. S. AGE-List Bfrthtitni ,..15090ER t YEJ Mom( tiays 03 oft): lAwouree'L0qATIONS:, 1 Et K $1431664.Gilili', Li 6. DOA .1,0 7..p.,,,,y) IF 05069 nouns Residence 04 HIM. minutes (any) 8. BIRTHPLACE (City State or Foreign Country) Enid, Oklahoma 8b. NAME OF HOSPITAL, NURSING HOME OR OTHER (If outside a fadlity, give street address al location) University 1850 7. SOCIAL SECURITY NUMBER 509 28 3166 FACILITY 8c CITY, TOWN, OR LOCATION OF DEATH Sal t Lake City i' 6d. COUNTY OF DEATH ,Sal t Lake Hospital 9. SURVIVING SPOUSE (/V I5,, give maiden name) 10 WAS DECEDENT EVER IN THE U.S. ARMED FORCES? ri 1. Yes ql 2. No 11. MARITAL STATUS l• 1. Never Married [13 3 Widowed Ll 2MrrIed J 4 bkweeti 120. DECEDENT'S USUAL OCCUPATION (Give kind of work done dint/4 most of working life. Do NOT enter retired) Oil Gas Exploration 12b. KIND OF BUSINESS OR INDUSTRY Oil Gas Industry 138. RESIDENCE-STREET AND NUMBER 2014 Bedford Road 13b. CITY, TOWN OR COMMUNITY Thayne 13c. COUNTY Lincoln 13d. STATE 13e. INSIDE CITY LIMITS? 0 1. Valk xi 2. No 13f. ZIP CODE 83127 14. WAS DECEDENT OF HISPANIC ORIGIN? 111 1. Yes E 2. No al yes, Speciry) II 1. can III '2. Cuban 0 3 Puerto Rican D 4. °then (Specify) 15. RACE Black, White, M. Indian (tribe may be entered), Japanese, etc. (Specify) White Wyoming__ 16. EDUCATION (specify only highest grade completed) Elementary or Secondary (0-12) College (13-18 05 17*) 12 PARENTS 17. FATHERS NAME (First, Middle, Last) Perry James Wilson MCCablin 18. MAIDEN NAME OF MOTHER (First, Middle, Last) Velma May Armor INFORMANT 19. NAME, RELATIONSHIP AND MAILING 4.005565 05 INFORMANT Ricky Edward McCaslin (Soil). Bo X 443 Big Piney, Wyoming 83113 DISPOSITION 20. METHOD OF DISPOSITION i I 1 Entombrnent0 2. Donation 0 3 Other ikj 4. Burial Li 5 Cremation. S Removal 21a. DATE OF DISPOSITION June 13, 2000 21b. PLACE (name of cemetery, Thayne Cemetery 21c. LOCATION City or Town, State Thayne, Wyoming 22 SIGNATURE OF FUNERAL SERVICE LICENSEE 23. LICENSEE NUMBER 115349 24. FUNERAL HOME (Neme and address) Goff Mortuary, Inc. CERTIFIER 25. DATE DEC SED WAS LAST ATTENDED BY CERTIFYING PHYSICIAN June 9, 2000 26 If not certified by medical examiner, was death reported to M.E.? 0 1. Yes U 2. No If yes, enter the date and hour reported. M.E. CARE NO: HR. _MO DAY YEAR 8090 So. State St. Midvale, Utah 84047 27, CERTIFIER rj 1. CERTIFYING PHYSICIAN: To the best of my Knowledge, death Occurred .1 /5. time, date, and place, end due to the cause(s) aricl manner as Meted. 2 MEDICAL EXAMINER/LAW ENFORCEMENT OFFICIAL: On,the basis of examination and/or investigation, in my opinion, death occurred at he time, date, place and due 10 15, cause(s) end manner as stated. 275. SI A /NM TITLE OF CERTIFIER r an.& tt ttli N 27c. LICENSE NUMBER 901827941205 2/ DATE SIGNED (Month, Day, Year) L.,,,,t. 12 1 2,606 28. NAME AND ADDRESS OF PERS 0 CERTIFIED THE .CAUSE OF DEATH (Item 31) (Type/Print) Theodore G. Liou, M. D.50 N Medical Drive, Salt Lake Citv, Utah 84132 REGISTRAR 29. REGISTRAR'S SIGNATURE ftdAVIV 45 30e. DATE REGISTRAR NOTIFIED OF DEATH (Mo, Oay, Yr) June 13, 200 305 DATE FILED (Mo., Day, Yr.) June 14, 2000 Y CAUSE OF DEATH I j upyi_Bvr Form 12, Rev. 12/98 IS to certr v 31. PART I. ENTER THE DISEASES, I ES, OR RESPIRATORY ARR SHOCK IMMEDIATE CAUSE (Final disease or condition resulting in death) or COMPLI iqNs THAT CAUSED THE DEATH. 00 501 ENTER THE MODE OF DYING, SUCH AS CARDIAC !Approximate Interval OR HEART FAILURE LIST ONLY ONE CAUSE ON EACH 1/145. Between Onset and jt 1,14, /1 e I Deseh. .41 k.,,,..14„a.„ .tiv..„ ttettt (-14-1.4 1 ,i Sat4.1,1_- I DUE Tfir(05 AS A CONSEQUENCE OF): C 1-I Sequentially Iis) conditions, if A CIITO (Oks,,,coypEot.piCIA): r any, leading to immediate cause. Enter UNDERLYING itttl..(t. /Q... '4.nr.ea rAt-tetu t'ext. 4.-- CAUSE (disease or Injury that DUE (OR AS A,q0NSiQUENCE OF): initiated events resulting in death) LAST d. I tAkcb4. ea-Lel-04c ,p,Lum-cA,vtistA.4,,, tAA4 II, 'PART if. Other Significant Conditions contributing to death but not resulting in the undedying cause given in Pert I IN ,UR OPINION, TOBACCO USE BY THE DECEDENT: 1, Probably contributed 10 155 cause of death. 5. NON USER Waft the underlying cause of death. III S DO not contribute to the muse of death. 6. rater 0 4. Is unknown in elation to the cause of death. 33a WAS AN AUTOPSY PERFORMED? EA 1. Yee 0 2. No 335 WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? VYes 0 2. No 34. MANNER OF DEATH 1. Natural [1 Accident r 13. Suicide 0 4. Homicide J 5. UndeterminedEj 6. Pending If injured I.--- 1„..ti Purposely or Accidently that this is a true copy 35e. DATE or mum (Mo., Day, Yr.) 35b. TIME OF 35c. INJURY AT WORK? 1. Yes •2. No 35d. gggE f s Apy r nier, farm, street, fecf00/, 35s LOCATION (Street or nivel route number, city or town, county and stale.) 35f. If motor vehicle accident specify if decedent was driver, pas or pedestrian. 35s DESCRIBE HOW INJURY OCCURRED (enter sequence of events which resulted in injury, NATURE OF INJURY shoutd be entered In item 31) of l'hoii nc,rfifi,--;f., fa- 1,, rt.:- _rx:_ 0866675 739 (r STATE OF U TA H DEPARTMENT OF HEALTH AccesaloWarimflonon llaskimaftilW maw TAM the Vital Slaltsfics 18-2504 R"'" LOCAL FILE NUMBER This cerunea copy s issue under authority of section 26-2-22 of the Utah Code Annotated, 1953 As Amended, 17 Date Issued: z_ JUN 1 4 2000 L0 0) E r County Salt Lake co o Registrar '71 L017332 TAH:' OF HEALTH FiCA E OF DEATH olga4) 11 Barry E. Nangle DIRECTOR OF VITAL RECORDS By 41644degotwm040 ANY ALTERATION OR ERASURE VOIOS THIS CERTIFICATION -7- "T" 0S4.51 IT IS ILLEGAL TO DUPLICATE THIS COPY FOR OFFICIAL PURPOSES. \ts:40 k EXHIBIT "A"