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LINCOLN COUNTY FEES: $15.00 PAGE 1OF 2
BOOK: 840 PAGE: 858 AFFIDAVIT
JEANNE WAGNER, LINCOLN COUNTY CLERK
1111111111111111111111111111111111111 I I I 1111111111111111111111111111111111111111
AFFIDAVIT OF TRUST
1. That I am a successor trustee of the LaMont R. Merritt Revocable Trust
dated the 10th day of September 1997.
2. That on October 27, 1997 in Book 403PR, Page 293 of the records of the
Lincoln County Clerk was recorded a Warranty Deed /Quitclaim Deed from LaMont
R. Merritt to LaMont R. Merritt Revocable Trust dated the 10th day of September
1997 conveying the following described land:
W /2SW /4 of Section 19, T31N R118W of the 6 P.M., Lincoln County,
Wyoming.
EXCEPTING THEREFROM the land described in document recorded in Book
111PR on page 486 of the records of the Lincoln County Clerk.
EXCEPTING THEREFROM the land described in document recorded in Book
170PR on page 611 of the records of the Lincoln County Clerk.
EXCEPTING THEREFROM the land within the Viewmont Subdivision, Lincoln
County, Wyoming, as described on the official plat filed with Instrument No.
542005 of the records of the Lincoln County Clerk.
3 That LaMont R. Merritt died on July 10, 2013 as shown on the certified,
copy of the decedent's death certificate attached to this Affidavit and, pursuant to
the provisions of said Trust, Kelly Merritt is the successor Trustee.
State of Wyoming
)ss
County of Lincoln
I, Kelly L. Merritt, do solemnly swear that I have reed the foregoing Affidavit
subscribed by me; that I know the contents thereof and verify believe the
statements therein contained are true.
Subscribed and sworn to (or affirmed) before me this
October, 2014 by Kelly L. Merritt.
Witness my hand and official seal.
My commission Expires: oavar l
Kelly L. Merritt
Kelly L. Merritt
day of
Notary Public
ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE
Nrmanyinr
Decedent:
Name:
Gender:
Date of Birth:
Date and Place of Death:
Date of Death:
City of Death:
Location:
Additional Decedent
Place of Birth:
Residence:
Marital Status:
Armed Forces:
Name of Father:
Name of Mother:
Informant:
Disposition:
Method of Disposition:
Place of Disposition:
Funeral Home or Facility:
Facility: Schwab Mortuary, Afton, Wyoming
Cause of Death:
The immediate cause is listed on the first line followed by any underlying causes.
(a) Myocardial infarction
Other Significant
Conditions:
Manner of Death:
Certifier:
Type:
Name:
Address:
Date Filed:
712601
Information:
Afton, Wyoming
Afton, Wyoming
Married Lee F Taylor
Yes
Ray Marcellis Merritt
Ethel Charolate Rich
Lee F Merritt
yrn9lt1'p y Zvi
CERTIFICATION OF VITAL RECORD w�
STATE OF WYOMING
LaMont Rich Merritt
Male
July 03, 2013
Afton
Star Valley Medical Center 110 Hospital Lane
Burial
Afton Cemetery, Afton, Wyoming
COPD Pneumonia Dementia
Natural Death
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
State File Number:
Social Security Number:
Age at the Time of Death:
County of Death:
Relationship:
Physician
Allen D. Carter, M.D.
110 Hospital Lane, PO Box 579, Afton, Wyoming, 83110
July 17, 2013
This is a true certification of the document on file in the office of Vital
Statistics Services, Cheyenne, Wyoming.
DATE ISSUEdursday, July 18, 2013
a,„QS /79`a;14 James McBride
Deputy State Registrar
2013- 002140
82 years
Lincoln
Wife
Interval:
Time of Death: 12:20 (Actual)
This copy is not valid unless prepared on paper with an engraved border. r.�1L
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