HomeMy WebLinkAbout918709
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XTO ENERGY, INC OWNER:: 0,OC¡O
For:
AFFIDAVIT OF HEIRSHIP
Re: fo~f fed ,u 4r to LvS
(Well/Property)
Legal Desc.: .s ec...: (131 L{/ &. J I, /3 /9 ztl¡ '3.}, '33
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County/State: '-í tl co (V\ e () I L) t j : '
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(City) (
, residing at ¿ 6
(Address)
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being first duly sworn, on oath deposes and
says that the answers and other statements
hereinafter set out are true and correct.
1. How long and how well were you
acquainted with the decedent?
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2. If related to decedent, state in what way.
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3. When and where did decedent die?
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4. Where was decedent's permanent residence at the time of his/her death?
5. How many times was decedent married?
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6. Name and address of surviving spouse (if any).
7. If decedent was ever married, list in the following table each such marriage, indicating in each instance the date
of marriage, the name of spouse, whether such marriage was terminated by death or divorce, the date of termination of the
marriage, the address of each spouse now living, and (if dead) whether or not such spouse left a will:
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RECEIVED 5/2312006 at 11 :06 AM
RECEIVING # 918709
BOOK: 621 PAGE: 26
JEANNE WAGNER
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J:;:;;'~~¡;::'ILlNCOLN COUNTY CLERK, KEMMI::):::::;:::;·:',iijVY
lit dead, did
¡such spouse
leave a Will
I
Date of Name of Spouse
Marriage
Marriage Date of
Terminated Termination
by Death or
Divorce
Address if Living
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B., (a) Wh,en was the property described at the beginning of the affidavit acquired by decedent.
(b) Was it acquired by gilt, devise, inheritance or purchase? (State which) '::¡:ÓÚJ,4
(c) If by purchase give the following information:
(1) Where did decedent reside (the State in which decedent had his/her permanent residence will suffice)
when property was acquired? 6 AI (;./tlð. // fA aC?tJl("~d thrðllC¡ j, rqfh e ("
J ~ II" jÁ t tI ~rd .A. ~ /loX£1I ð!
(2) Was the decedent married when such prope~y was acquired? C d,av {? û f Jd' / .:L ¡j /JJ ^-
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If so, give the name of decedent's husband or wife.
If such husband or wife is now deceased, did such party leave a Will?
9. Did Decedent leave a Will?
Vb
If so, (a) was the Will probated?
If the will was admitted to
probate, name all counties and states in which it has been probated and give the name and address of the
executor or administrator.
(b) Has there been any contest of the Will or appeal from the order admitting it to probate?
Alb
To your knowledge, is any such contest or appeal contemplated? ¡f/ 0
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10. If decedent did not leave a Will, was any administration had on decedent's estate? ¡t¡ b
u
If so, name the counties and states in which administration was had and give the name and address of the
administrator.
11. To your knowledge are there any debts or Federal estate or state inheritance taxes still owing by decedent's
estate? yO If so, will decedent's personal estate be sufficient, in your opinion, to pay such debts and
taxes?
What is the estimated net value of the entire estate?
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12.
If Dead, Give
Date of Death
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, 3. Give il1formation called for in the following table concerning descendants of any deceased child of decedent ...1,:1..~~('j ,:,09
, whethe,r natural or ado ted. If no descendants. so state. T'I i j~: 8
Name of Deceased Child Descendants Birth Address Living or IIf Dead, Ive -'
Date Dead Date of Death
14. If decedent left surviving no child or descendant of a child, then list names of decedent's parents and brothers
and sisters and give information called for in the following tables. If half brother or sisters, state whether
maternal or parental.
Name
Address
Living or
Dead
If Dead, Give
Date of Death
Father
Mother
Brother
Brother
Sister
Sister
Descendants of deceased brothers and sister. If none, so state.
Name of Deceased Descendants Address
Brother or Sister
Age Living If Dead,
or Dead Give Date
of Death
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15, If decedent left no children or their descendants, or father or mother, or brothers or sisters or their
descendants, then ive the information called for in the followin tables:
Name Address
Living
or
Dead
If Dead,
Give
Date of
Death
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Name
luncle or Age IPaternal or
Aunt Maternal
¡AddreSs
/Living
or
Dead
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If Dead Give
Date of Death
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Name bfDeceased Uncle
or þ,unt
,.,,·,t;"·,
Descendants
Subscribed and sworn to before me this
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lit Dead
Give Date
of Death
Age Address
/LiVing
or
Dead
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My Commission Expires:
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County,
.,~
"Notary Public" -~
Elizabeth A. Noonan
CommO~Wealth of Massachusetts
My CommISsion Exp¡r,"-:; OIl Juty 28, 2011
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