The URL can be used to link to this page

Home My WebLink About976991 Affidavit of Successor Trustee I, Dennis McEvoy, being of lawful age and duly sworn according to law, upon my oath depose and state: That under the date November 17, 2005, Delbert L. Allen and Carmen Allen, as joint tenants by deed of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk on December 9, 2005, in Book 607 on Page 269, conveyed to Delbert L. Alien and Carmen Allen, trustees, or successor trustee(s) of the Allen Family Trust dated November 17, 2005 and any amendments there :o the following described property situate in Lincoln County, Wyoming, to -wit: Lot 139 of Star Valley Ranch RV Park Plat One (1) as platted and recorded in the official records of Lincoln County, Wyoming That by reason of said conveyance aforesaid, Delbert L. Allen and Carmen. Allen trustees or successor trustee(s) of the Allen Family Trust dated November 17 2005, became the owners of the above described land, and title thereto vested continuously in said trustees from the date of conveyance described in said deed, to the date of death of Carmen Allen, on the 25th day of November, 20o5 and to the date of death of Delbert L. Allen, also known as Delbert Leon Allen, on the 15th day of October, 13. That by reason of and upon the deaths of Carmen Allen and Delbert L. Allen, also known as Delbert Leon Allen and pursuant to Article One, Section C. of the Trust Agreement, title to the above described real property vested in Dennis McEvoy, as trustee. Affiant avers and certifies that Carmen Allen and Delbert L. Allen, also known as Delbert Leon Allen, are the identical parties named as trustees in the aforementioned deed, whose deaths terminated their interest, title and estate in said real property; and Affiant attaches hereto and makes a part of this affidavit, the Official Certificates of Death of said decedents, duly certified by the public authority in which said death certificates are a matter of record. Dated this 3 day of 1 2014. Y-Q De Cp. McEvoy State of )ss. County of Subscribed and sworn to before me, a notary public in and for said County and State, by Dennis McEvoy, this day of 2014. WITNESS my hand and official seal. n Notary Public My Commission Expires: 976991 6/11/2014 1:59 PM LINCOLN COUNTY FEES: $21.00 PAGE: 1 OF 4 BOOK: 833 PAGE: 804 AFFIDAVIT JEANNE WAGNER, LINCOLN COUNTY CLERK 1111 11,111111111 1 11 1111IIIII I 1 111 CALIFORNIA JURAT WITH AFFIANT STATEMENT �r crcr�i' crc� cFycrc�. �S' �s�c�' �syc�`< �rc�, crycr., c��r�r, .r_.�rcrcrcr,�rcrc.<>cr�cr�ri:� �cr_.cr_�r�rccycrc `''See Attached Document (Notary to cross out lines 1 -6 below) C1 See Statement Below (Lines 1 -5 to be completed only by document signer[s], nor Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 any) State of California County of &,-/A‘t Subscribed and sworn to (d) before me on this day of ��(ill -e 20 by Date Month Year (1) Name of Signer L. K. ROACH proved to me on the basis of satis ctory evidence NOIT P •CALIF to be the person who appeared before me COMMISSION 2009970 /s SANTA CLA RA COUNTI r and My Co mm Exp. March 18, 2017 (2) Name of Signer proved to me on the basis of satisfactory evidence to be the person who appear-d befor e.) Signature S .nature of Notary Public Place Notary Seal Above OPTIONAL Though the information below is not required by law, it may prove RIGHTTHUMBPRINT. RIGHT THUMBPRINT valuable to persons relying on the document and could prevent -OF SIGNER #11 OF SIGNER #2 fraudulent removal and reattachment of this form to another document. Top of thumb here Too of thumb here Further Description of Any Attached Document 1 �,I Title or Type of Document: j Document Date: 1 4 Num er of Pages: Signer(s) Other Than Named Above: d 1'140 ,`c C:'.. C,`r Z x L`c =cx_x sic <`z%C.`u,`c t,`eic,s K; c ,`t.t,`Gcs ,•ci tx,x tx%(x∎;>t C ,x_xJU;• C2007 National Notary Association 9350 De Soto Ave., P.O. Box 2402 Chatsworth, CA 91313 -2402 wvhv.NationalNotary. org Item 95910 Reo der: Call Toll -Free 1 -600- 876 -6827 STATE OF HAWAII CERTIFICATE OF DEATH DEPARTMENT OF HEALTH STATE OFFICE OF HEALTH STATUS MONITORING FILE NO. 151 1. DECEASED FIRST NAME MIDDLE NAME LAST NAME 2. SEX 1 DAT OF DEATH (MONTH, DAY, YEAR) Carmen Allen Female November 25,. 2005 ED 4a. RACE 40 IS PERSON OF SPANISH ORIGIN? 5a. AGE-LAST se UNDER 1 eR 50. UNDER I DAY 6. DATE OF BIRTH )MGNrH, DAY, YEAR) D 7e COUNTY OF DEATH 1 O Puel o Nun 2 0 Mexican 3 O CMtan BIRTHDAY (Yews) 90 5. DAY5 HOUR5 MIN. Caucasian 0 4 tiMn S sp„e„D,,,,, Lx 72 December 30, 1932 5 ❑orwauNeoan Maui 70 -1. ISLAND OF DEATH 7b. CITY, TOWN OR LOCATION OF DEATH 7c. HOSPITAL OR OTHER INSTITUTION NAME (IF NOT I6 ERNER, GIVE STREET AND NUMBER) 71 IF HOSP. OR INST. INDICA75 DOA, OPIEME9. Na, 9847IEM )5PE0■FI') Maui Wailuku Maui Memorial Medical Center Inpatient 8. STATE OF BIRTH (IF NO7 IN U.S.A., NAME CDIAne7 9. CITIZEN OF WHAT COUNTRY 10 MARRIED, NEVER MARRIED, WIDOWED, 11, SURVIVING SPOUSE OF wIF=_. GIVE MAIDEN NAME 12. WAS DECEDENT EVER IN U.S. ARMED DIV RCED 15 FOR S7 MA.* VA 9, O) Utah USA S' ^f ivlarrie Delbert Leon Allen 13. SOCIAL SECURITY NUMBER 14a. USUAL OCCUPATION (GIVE KIND CF WORK DONE WRING MOST OF 14b, KIND OF BUSINESS OR INDUSTRY 140 EDUCATION WORKING LIFE, EVEN IF RETIRED) Mee* NeReel Vale come.1e0 528-36-6041 Surgical Technician Z Private Hospital 8 12 15a. RESIDENCE -STATE 158, COUNTY 15c. CITY. TOWN OR LOCATION I I54. INSIDE Cm LIMITS 159. NUMBER, STREET AND ZIP Nevada Clark Mes u it e I SPECI Y ES OR N01 q I0 1384 Harbour Drive 89027 1 18. FATHER FIRST NAME MIDDLE NAME LAST NAME 17. MOTHER FIRST NAME MIDDLE NAME MAIDEN NAME Worsencroft 1Be. INFORMANT NA ME 1811 MAILING ADDRESS (STREET OR 6.0 Box, CITr OR TD, STATE, P) is Delbert Leon Allen 1 Harbour Drive, Mesquite, Nevada 89027 19x. BURIAL, CREMATION, REMOVAL 1917 CEMETERY OR CREMATORY -N Ym ZI 190. LOCATION CITY TOWN STATE It (SPECIFY) Cremation Ballard Family Crematory Kahului,, Hawaii DN 19d. DATE 9AOINTH, DAY, YEAR) 19e. PERMIT NUMBER 20a, FUNERAL HOME -NAME 2017 FUNERAL ORE� 0R- SIGNATUF7 OR r' November 28, 2005 798 Ballard Family Mortuary e 1a. To 111e beet of my knowledge th occurred al the time, data and place and due to the cause i s) and circumstances 'e c op 22, u ne( On s) the end cl beala o rcume tanc f a%em inatlon sU ted and/or and tles Inveatlgatl eri betl m, elo In w (Hems 8221 thr m U I I stated and described below Ole b through 8279 where applicable) 8225 tlwlh ough e27 oecurratl g wh at ere Ihs epplleable) Ilma, tlale and place and due to the t �s (Slgnefure one MOO. 7 /C :=w (Signature end T7fleJ, e 211. DATE SIGNED (MO., 0' YR.) 21c TIME OF DEATH -J lit 22b. DATE SIGNED (MO., DAY, YR) 220 TIME OF DEATH N OF F November 28, 2005 8:29 P M EIN 211. NAME ATTEFgeNC PHYSICIAN OTHER THAN DERRFIER (TYPE OR PReli) Z M R es 3 �w C 2d. PRONOUNCED DEAD (MO., DAY, YR) 22e. PRONOUNCED DEAD (TIME) o Ee y cc at M It 23. NAME AND ADDRESS OF CERTIFIER (PHYSICIAN, MEDICAL EXAMINER OR CORONER) (TYPE OR PRINT) g0 Ronald Kwon, M.D. 99 South Market Street Wailuku, HI 96793 24a. REGISTRAR SIGNATURE 24b. DATE RECEIVED BY LOCAL REGISTRAR 240 DATE FILED BY STATE REGISTRAR NOV 2 8 2005 ')EC 5 2005 L PART I. DEATH WAS CAUSED BY: V ENTER ONLY ONE CAUSE PER LINE FOR (a), (b), AND (c) AAPRp %a1A7E INTERVAL BETWEEN ONSET AND DFATN N 0M0EDI406 CAUSE A r 7 0 C- 7( Cc ce- 6. s R 25. CONDITIONS, IF ANY, DUE TD, OR AS A CGNSEDUENCE OF. WHICH GAVE RISE TO IMMEDIATE CAUSE (a). N) STATING THE UNDER- LYING CAUSE LAST DUE TO. OR AS A CONSEQUENCE OF: I0) PART 11. OTHER SIGNIFICANT CONDITgNS: CONDITIONS CONTRIBUTING TO DEATH PUT NOT RELATED TO CAUSE GIVEN IN PAREgli 26a. AUIOP5Y (YES OR NO) No 261. IF 0E5, WERE FINDINGS CONSIDERED IN DETERMIN94G CAUSE OF DEATH? 278. ACCIDENT, SUICIDE, HOMICIDE, 276. DATE OF INJURY (MONTH. DAY. YEAR) 27c. TIME OF IMAM( -7. ,T'L 7 27d. DESCRIBE HOW INJURY OCCURRED UNDETERMINED DETERMINED (SPECIFY) 27e. INJURY 47 WORK 271. PLACE OF INJURY -AT NOME. FARM. STREET. FACTORY, OFFICE BIM, ETC (SPECIFY) (SPECIFY YES OR NO) 27 9. LOCATION (STREET OR R.F.D. NO., CRY OR TOWN, STATE) DEC 1 2 2005 CERTIFY THIS IS A TRUE COPY OR ABSTRACT OF THE RECORD ON FILE Si THE HAWAII STATE DEPARTMENT Of HEALTH O jArten. L0 STATE REGISTRAR L/ STATE OF NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH VITAL STATISTICS CERTIFICATE OF DEATH 1 20+3016906 1 I TYPE OR STATE FILE NUMBER 1 I PRINT IN 1a. DECEASIDALA•ME �FIRST.MH3L31_E,Lt1ST.SUFFIX) 2 DATE OF DEATH O Jay'Ysarl 3a. COUNTY OF DEATH -i PERMANENT Delbert Leon ALLEN Ctober15, 2J13 Clark 1 BLACK INK 3b. CITY, TOWN, OR LOCATION OF DEATH 3c. HOSPITAL OR OTHER IN ;Tf ITION 44;1In e(if net eltner, glue street 3e .if Nosp. or In ;it. Inelrate DOA,OP.'F_m er. Rm. 4. SEX and number) Inpatient(Speci ^n DECEDENT Mesquite 1384 Harbour Drive Home Male 1 5. RACE White 8 Hispanic Origin'? Specify 7a AGE- -Last 7b. UNDER I YEAR 7c.IJNDE 1 DAY 8. DATE OF BIRTH (Mo /Day/Yr) (Specify) No Non Hispanic ba1hclay tYears) MOS YS HOURS MINS 78 I DA December 19, 1$34 I rIDEATH 9a. STATE OF BIRTH (If not U.S.A_,. 98_ CITIZEN OF WHAT COUNTRY LL 11 MARRIED. NEVER MARRIED, WIDOW =0. i '2. SURVIVING SPOUSE (if Wife glue OMAR name country) Utah United States DIVORCED (Specify) wid maiden na IN`1#N UT 16.. 1 HANDBOOK 13. SOCIAL SECURITY NUMBER 14a. USUAL OCCUPATION (Give Kind of Work Done During Most 14b. KIND OF BUSINEi SS OR INDUSTRY Ever in US Armed REGARDING 528-42-2829 of Working Life, Even If Retired) COMPLETION OF Stock Broker BrckeraDe Forces? Yes I RESIDENCE 15a. RESIDENCE STATE 15b. COUNTY 15c. CITY, TOWN OR LOCATION 15d. STREET AND NUMBER 15e INSIDE CITY ITEMS LIMITS (Specify Yes 1 1 j Nevada Clark Mesquite 1384 Harbour Drive or No) Yes PARENTS 18. FATHER/PARENT-NAME (First Mcddre -Last Suffix) 17: MOTHER/PARENT -NAME t1=}rst Middle Ast Suffix) \Ierrl+on Lean ALLEN RLth f, RGEDER a. INFOrzM''s='T"- NAML LT-Ale °nip. 11ktb. MAILING Anl`RLE 0 (S'- ?r or R.,/.D. Na 'C +sgfl r. e` n S er 7iir Cory ORSENCROFT I 12044 Hidden Valley Club Drive Sandy, Utah 84092 1 19a. BURIAL, CREMATION, REMOVAL, OTHER (Specify) 19b. CEMETERY OR CREMATORY NAME 19e:. LOCATION City or Town State DISPOSITION Removal /Cremation Metcalf Mortuary Saint George Utah 84770 20a. FUNERAL DIRECTOR SIGNATURE Or Person Acting as Such) 20h. FUNERAL 20c. NAME AND ADDRESS OF FACILITY BRIAN REBMAN DIRECTOR LICENSE- Mo apa Valley Mortuary SIGNATURE AUTHENTICATED 49 5990 N- Moapa Valley Blvd Logandale NV 890a= TRADECALL TRADE CALL- NAME AND ADDRESS es. I n z 21a. To the best of my knowledge, death occurred at the time date and p and n 22a. On the basis of examination and, or Investigation, in my opinion death Occurred at m U due to the cause(s) stated. (Signature Ttle) SIGNATURE AUTHENTICATED 2 o the time, date and place and due to tl cause(s) stated. (Signature Title) J N ENRIQUE ALFARO M.D. L 0 i CERTIFIER E a 21b. DATE SIGNED (Mo /Day/Yr) 21c. HOUR OF DEATH c in 22b. DATE SIGNED (MO /DaylYr) 22c. HOUR OF DEATH 1 8 October 16, 2013 17 :2 5 8 N 0 al 21d. NAME -OF ATTE#�IDING PHYSICIAN IF OTHER THAN CERTIFIER m 224 PRONOUNCED DEADTMoiDayrfe). -2e T'RONOIJNCED DEAD AT (Hour). -I 4 E (Type ar Pori) t0 L, j 23a. NAME AND ADQRESSOF CERTIF1€R(PHYSICIAN, ATTENDING PHYSICIAN, MEDICAL EXAMINER. OR CORONEyper Prinf) 7;238. LICENSE NUMBER i E nrique Alfaro M.D. 1301 Bertha Howe Ave., Suite 1 Mesquite, NV 89 10328 REGISTRAR `4a. REGISTRAR (Si LIZ MUNFORD 24b. DATE RECEIVED BY REGISTRAR 21c. DEATH DUE TO COMMUNICABLE DISEASE i SIGNATURE AUTHENTICATED (MO /Day Yr) October 17, 2013 YES Ei NO el _i CAUSE OF 25. IMMEDIATE CAUSE (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b), AND (c).) I Interval between onset and death n PARTI (a) Terminal chronic obstructive lung disease Years 1 DUE TO, OR AS A CONSEQUENCE OF Interval between onseLand death /I CO (b) or Emphysema ANY WHICH GAVE RISE TO DUE TO, OR AS A CONSEQUENCE OF Interval between onset death IMMEDIATE CAUSE (0) STATING THE DUE TO, OR AS A CONSEQUENCE OF: Interval between onset and death UNDERLYING CAUSE LAST _1 PANT 11 OTHER CONDITIONS- Conditions contributing to death but not resuiti lg in the underlying causegivenm Parr= 12 67 AUto''SV 27. WAS CASE REFERRED Speo 1 Sss fy or No) TO CORONER (Specify Yes No e rno) Yes 20 ACC SI11F09E HOM- 5 JNDET. 04.458. DATEO4- INJI IRY (M,IDay /Yr) 25r. HQ(IR OF 15)1117Y 20 DE SC5105 HOW INJURY OCCueeoo PENDING INVL:S -T_ (Specify) 28e. INJURY AT WORK (Specify 28f. PLACE OF INJURY- At home, farm, street, factory. office 28g. LOCATION STREET OR R.F.I:. No CITY OR TOWN STATE Yes or No) building, etc. (Specify) 1 STATE REGISTRAR r.....) CID D 4::::::. T- "CERTIFIED TO BE A TRUE AND CORRECT COPY OF THE DOCUMENT ON FILE WITH THE REGISTRAR G 'VITAL TATISPieS, YSRv- ,'9tzps STATE OF NEVADA." This copy, was issued by the Southern Nevada Health District from State certified documenls�as authorized biz- a r.� State Board ofileaffh ffrsffaft to 440.175. C G J ahn IvliddaLtg7r�3 D NOT VALID WITHOUT THE RAISED Registrar of V tal'Statistics_ c C SEAL OF THE SOUTHERN NEVADA 4' rr B -1u) si HEAL DISTRICT y w n72U Date Issued: C� 1 SOUTHERN NEVADA HEALT H DISTRICT P.O. Box 3902 s Las Vegas, NV 89127 702- 759 -1010 Tax ID #88- 0151573 t ;tea