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Affidavit of Survivor Trustee -
I E' ~' ''
~_-
I, Veronica A. Peverley, being of lawful age and duly sworn according to
law, upon my oath, depose and state:
That under the date of October 22, 2001, Guy D. Peverley and VerOnica
A. Peverley, by deed of that date, which deed was duly filed of record in the
Office of the Lincoln County Clerk, on October 26, 2001, in 'Book 475 of
Photostatic Records on Page 530, conveyed to Guy D. Peverley and Veronica A.
Pevefley, trustees of The Guy D. Peverley and Veronica A. Peverley Living Trust,
dated October 22, 2001, the following described property to-wit:
. Lot 73 in Star Valley Ranch Plat 13, Lincoln County, Wyoming
That by reason of said conveyance aforesaid, The Guy D. Peverley and
Veronica A. Peverley Living Trust, became the owner of the above described
land, and title thereto vested in Guy D. Peverley and Veronica A. Peverley,
Trustees, continuously from the date of conveyance described in said deed to the
date of death of Guy D. Peverley, also known as Guy DeWitt Peverley, on the 7th
day of January, 2002. That by reason of and upon the death of Guy D. Peverley,
title to the above described real property vested absolutely in Veronica A.
· Peverley, as the surviving trustee.
Affiant avers and certifies that Guy DeWitt Peverley is the identical party
named with Veronica A. Peverley as Trustee in the aforementioned deed whose
death terminated his interest, title and estate in said real property; and Affiant
attaches hereto and makes a part of this affidavit, a copy of the Official Certificate
of Death of said decedent, duly certified by the public authority in which said
death certificate is a matter of record.
Dated this ¢,¢/~day of (~~ ,2003.
Veronica A. Peverl~y
Jl
State of ))ss:
County of )
Subscribed and sWorn to before me, a qotary public in and for said County
and State, by Veronica A. Pever!ey, this ~day of('~ ,2003.
'WITNESS my hand and official seal.
] cou, TYOrST^TE OFt
L~NCOLN ~¢' WYOMINGt
Notary Public
My Commission Expires~tC2..XJ_J~
!
FOR
INSTRUCTIONS
SEE
HANDBOOK
3
LOCAL FILE NUMBER
Jr DECEDENT.NAME FIRST
4. SOCIAL SECURITY NUMBER
$20- 18-7957
?a_ PLACE OF DEATH (Che~k o~y ~)
sm'E oF w oM,.
CERTIFICATE OF DEATH
~ATE
DeWlTT PEVERLEY Male January 7, 2002
J~'Am'-"'~'' I ~'u"~" ' ~EA" 1~-,7 2 ~~:' uN~), DA~.. ~0. OAT~ O~ ~,m.~, ~. ~,.~October l, 1929
[] Inl~li~nl [] ER/Oull~alie~l ~] DoA'TOTrtER:
[:]Nu~.,Ho... C:],o.~,,~. I~-o~,rs~.; Familys Residence
525 Bramwell Street
Wyoming
11. WAS DECEDENT EVER IN U.S. ARMED FORCES?
(S~ec~ty yes ~' ~/
138. RESIDENCE . STATE I 13b. COUNTY
Wyoming I Lincoln
7C. CITY. TOWN, OR LOCATION OF DEATH
Green River
g. MARRIED. NE'VER MARRIED, I IO. SURVNING SPOUSE (II w~t~, ~
WIOOWEO. DIVORCED(.~oecttY)Married J Veronica Dunning
Retired Environmental Manager
13e. INSIDE CITy LNITS?
13c. CITY, TOWN OR LOCATION
Thayne
Peverley
~ Howard DeWitt
lg& INFORMANT-NAME (T~ ~ ~)
Mrs. Veronica Peverley
CITY OR TOWN STATE
Post Office Box 887 Thayne, Wyoming
208. Bur~l. C. mm~lion Removal 2Ob. DATE (Mo. Day Yr.) 120c CEMETERY OR C~MATO~ ~ME
Burial Jan Il 2002 iv '
.d · , R ervmw Cemetery
~~////~[~,.~406 Vase Flaming Gorge Chapel
122C' HOU~DEATH
January 11, 2002 1:5
DATE ,.~GNE'I (1~0., De't,
,COUNTY OF DEATH
Sweetwater
12b. KINO OF BUSINESS OR INOU$'iiY
Trona Mining and Processing
I1~. STREET AND NUMBER
1278 Vista Drive
Wh ite E,.,~,.,-t~s.:,.~,~12 ~°'~lc~'~ ' '~ ~'5
I
/
Hester Taylor
Wife
83127
2~. LOCA~ CITY OR ~ ~AE
Green River, Wyoming
~'~'~'~[P~7lming Gorge Way
01 Green River, Wyoming
~$ . January 11, 2002 1:50 P M
January 7, 2002 2:50 P M
John A. Iliya, M.D., 1208 Hilltop Drive,
25e. REGISTRAR
VR 2-89
11/99 15M
IMMEI~ATE CAUSE (Final
Rock Springs, Wyoming 82901
2Sb. DA~ RECEIVED BY REGISTRAR (MO., Oalr. Yr.)
January 11, 2002
Bequem~y Iht cond~on~.
CAUSE (Oi~e ~' injury
Lung Cancer
DUE TO (OR AS A CONSEQUENCE OF):
DUE TO (OR A~ A CONSEQUENCE OF):
DUE To (OR A~ A CONSEQUENCE OF):
I Year
N, RT II. OTHER SIGNIFICANT CONOITIONS-Co~Iitlo~ conuib~i~g I~ ~am b~ ~t ~t~ lo ca~ ~ ~ ~ L ]27. ~PSY (S~128. ~S C~E RE~O TO CORONER
I
No / Yes
' z' ':-,,~.". V I~ '~FUN ' L HOME
:~.:?~,,~, .'/~1~. :.~ -3'o mi n g 82901
~;qh/;t ',,~,~.~.:.~ ....
.: .
DATE ISSUED January 15, 2002
THIS IS..TO CERTIFY THAT this is a true correct conformed reproduction of the original
copy p'f~}h~.e,/,du,e.a, tb.ce4-tificate completed by the VASE FUNERAL HOME and submitted
to t~~~..QRDS SERVICES, Wyoming Department of Health and Social Services,
Di,~~:~i~dical Services at Cheyenne, Wyoming.
' i":.~.~'" ~ --C%.../ ') STATE OF WYOMING)
: k..._ ~/~-~/.~/~2:~./X~/ COUNTY OF SWEETWATER )ss
Subscribed and sworn to before me a Notary Public
this 15th day ,.f .January ,-~20 02
My ":'.;¥..dssion expires on April 21, 2c^*