HomeMy WebLinkAbout909552STATE OF WYOMING
COUNTY OF LINCOLN
AFFIDAVIT OF HEIRSHIP
Decedent Owner No:
Decedent Name:
Lease Number:
Lease Name:
80318
Marqaret C. Hose
WY5166.19, WY5166.191
Shute Creek 50-31
Legal Description: TWN 23N~ RNG l12W
Section 31' SE/4NW/4
BEFORE ME, the undersigned authority, on this day personally appeared LOIS L. COOK ,
well known to me to be a credible person, who being by me sworn to tell the truth, the whole truth, and
nothing but the truth, made the following answers, in my presence, and having completed said
answers, he/she subscribed them in my presence, and swore the same were true to the best of his/her
knowledge and belief.
2.
3.
4.
State your name, age, and present address:LLO.Lg_Ug~7~ 9~nn IJIJTTI:' n^Vq T^W nD~T/~/~ ~ E IL
· · _--_-- 7~ ~,,- -- '~- - 7~;~~'~'' ''¢ :' - v v -'r' ..... .'~. ......
Were you acquamted w~th <<Ownername>> (the Decedent ) durmg h~s/her hfebme? YES
How long did you know the Decedent? .~25 yFAl~g
Approximate date of his/her death: gAN. 1 7,2004
State whether or not the Decedent was ever married. YES ~!,!! DOt,!
(a) How many times? NOT APPL!CABLEI;~ --
(b) Name of spouse or spouses and approximate date of marriage of each: RAYMn~n A H~SE
(c) State whether spouse(s) are now alive or dead, and if dead, give approximate date of
death: f/FFF/~qFI~ '~H v 9~
(d) Did any spo~i~7,~--an~y~,~¢ll ~,i~l~i'n~ur knowledge?
(e) Within your knowledge, was there any administration of any spouse's estate?NOT APPL!CABLE
If sO,. where,
(f) If Decedent was divorced from any spouse, state name, date, and place of divorce:
NflT APPLICABLE
Did the Decedent leave any will within your knowledge? YES
Was there any administration of the Decedent's estate within :,'our knowledge? f~',l p pF)cEss
If so, give name and address of Executor or Administrator Wfll rAH H_ Hf')gF
129 LAKESHORE DR. BLUE EYE,HO. 65611
and where such administration (is) (was) pending: SEBONA,ARIZ.
If you have answered that there was no administration of the Decedent's estate, please state to
the best of your knowledge what debts, if any, were left by the Decedent:
Give names of all Decedent's children, including adopted children, if any, and including any
children who are now dead, and give the present addresses and ages of all living children:
I If Deceased
Name Address Age Date of Death
WILLIAM H.HOSE,129 LAKESHORE DR. BLUE EYE,MO.65611 ADULT
SHERRILL HOSE AKYOL~ADULT~315 8th.AVE..'.NFW YnP~,NFW YOBK'10O0~
NOTE: If no children are dead, Question #10 need NOT be answered.
107~,, ~'(a) ~/-~- If~any 'children'~ a~re:dead~state%,:.,hether~'o'r-not~a'n~fffi~h~h-fl~l-I~¥t-~-~ilh
(b) Give the name and present address of any surviving spouse of each such deceased
child:
(c)
Give the names of all children, both living and dead, of each such deceased child and
the present addresses of all living children:
Name and I If Deceased
Child of Address Age Date of Death
RECEIVED 6/28/2005 at 11:20 AM
RECEIVING # 909552
BOOK: 589 PAGE: 508
JEANNE WAGNER
LINCOLIq COUNTY CLERK, KEMMERER, VVY
NOTE: If Decedent was survived by children or children of deceased children, Question #11 need NOT
be answered.
11. If the Decedent was survived by neither children nor their descendants, please answer the
following questions: ,
(a) Did the Decedent's fat~er or mother survive him/her, and if so, give their names and
present addresses:
Name [ Address
(b)
Name all brothers and sisters of the Decedent, both living and dead, stating the ages
and addresses of those now living and the date of death of those now dead:
If Deceased
Name Address Age Date of Death
(c)
If there are any deceased brothers or sisters give the names, addresses and the social
security numbers of the surviving children of each:
Name [ Address [ Age [Childof
Subscribed and sworn to before me, on this
16
SEAL
Notary Public in and for Christian
County, State of Illinois
AFFIANT
day of June ,20 05
CORROBORATING AFFIDAVIT
(TO BE EXECUTED BY PARTY OTHER THAN THE ABOVE AFFIANT)
STATE OF Illinois )
) SS.
COUNTY OF Christian )
, of lawful age, being first duly sworn, on oath states:
That th-e-affi-ahi-W~S:W~ll ~-~]-15e~-6;q-~iiY ~cqd'~int'g~l'Wi~h'il~--~~t 'i~'-~is/her lifetime; that this
affiant has read the foregoing Affidavit of Heirship, knows the contents thereof, and that each and
every statement therein contained is true to the best of his/her knowledge and belief.
AFFIANT
Subscribed and sworn to before me, on this
day of ,20
SEAL
Notary Public in and for
County, State of