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RECEIVED 10/6/2008 at 10:42 AM
RECEIVING # 942670
BOOK: 706 PAGE: 289
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
000289
AFFIDAVIT OF HEIRSHIP
INFORMATlO CONCERNING Jess A. Tolerton DECEDENT.
..
Ï, J h n B. Rog e r s (affiant) being oflawfulllge, being first duly sworn, upon oath deposes and says:
TlII~tI Wits personally well a.cquainted with the above named decedent, during hislher lifetime, having known him (or her) for-4.0
years,. and thatll-filant b<\ars the followin¡¡relationship.to s.aid decedent, to wit his attorney· at 1 a w
1. Sàid decedent departed this life ~t C hey e n n e in L a r a ill i e CountylParish, State of
Wyomi ng . on Orllbout 9/6/2006 day, being-ª.Lyears Qld at the date of his (or her) death.
2. Sl .id Decedent owped, I .tthe time of his (or her) death, the land situated in Lincoln county/Parish, State ofWyom i ng
3. The land described IIbove was f~occupied as the homestelld of the deceued.
(circle one)
4. The land described above ~ow occupied as homestead of deceased's s\lrviving husbalJd ~
(circLe one) (oirc.le one)
5. The land described above iU@community property.
(circle one)
6. How did deceased acquire sllch interest? Ullkn own (deed, devise, inheritance or gift)
Affiant further s.tates that affiant was well acquainted with the family and near relatives orthe said Qecedent, and the following statements
and the answers to the following questions lire based upon the personal knowledge of affiant and are true and cOlTéct:
1. Did deo.er;lent leave·1\ Will? Yes (If so, attach a certified copy thereof.)
2. . Where was Will first admitted to probate? Give name of court, and also of the city, county, and state in which cOllrt is located:
Will was not admitt~d to probate
See below.
3.
Has Will bèen probated or admitted to record in the state where the above described land is situated? No
If so, give date,
4.
.name of court and county.
Is administra.1ion pending on the estate of decedent? N ()
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If so, in what court, county/parish and state?
5.
Ha.5 an executor or administrator been appointed for the estate of the decedent? No
Ifso, give his/her name and address.
6.
oyalty interest.
7.
What is the present condition of the administration? (Auswcr this question reganUess of whether or 110t decedent left a Will.)
Entire estate has been fully administered with exception
Has aQrninistra\ion been completed? Yes If so, has final order or decre.e of distribution been rendered by the Court? N / A
Were you acqwdnted with decedent's b~iness affairs? Yes Did decedent Jèave any debts or obligations unpaid? No
Have all such debts or obligations been paid? Yes
If not, how much remains unpaid? Non e What is reas.on these debts have not been paid? N / A
of this
/llClte: ./f docet.lent left u Will. hut .Taid Will "'a.T N01'prubuted. the laH'.! of IfllfJIJtute Descent w,d DI.su-lhurlon will apply, anti NOT rhe 'enn., of ,he Will.
INFORMATION CONCERNING HEIRS OF DECEDENT
8. Did decedent leave a surviving wife or h~band? Yes If so, give name & address: El i zabeth M.
prairie Avenue, #17, Cheyenne, NY 82009 Dateofm~lTiage: October 28,
Tolerton, 1406
1959Ifnot
9.
living, give date of dellth:
If the decedent was married more than once, give name or names of former ¡¡ouse or spouses, and .state whether any such former
.s.pouse is dead or div.orced, together with the d¡¡teòf death or divorce: N A .
..'
Give following information concerning all children born to decedent (legitimate or illegitimate), or legally adopted children of
decedent, who were lli:ini at the time of decedent's death: No chi 1 d r e n b 0 r nor ado p t e d .
10.
Name Address Childs Other Date of Birth
Parent
.- ,.,
2. Continued: 0.00112090 overiding royalty interest in Well 00009373-0001,
Blackjack Federal No. 30-11, located in the S 1/2 o{ ~eç~iQn II,
Township 22 North, Range 113 West of the 6th P~M., (t(.h~JÒ~irl".County, WY
11.
Give below the names of any ~ children of decedent: Non e
Name Date of Birth & Date of Surviving Spouse
Death
OOû290
Surviving Spouse Address
12. Give below the names of the living ~ of any dece.ased son or daughter (those listed above in Item # II) of the decedent: Non e
Name Date of Birth Name of Mother or Father from item Address
# 11 above
IF DECEDENT LEFT SURVIVING SPOUSE OR CHILDREN, THEN ITEM #13 BELOW MAYBE DISREGARDED ~
PROCEED TO ITEM #14
13. If decedentleft no surviving spouse or children, give the following information in the following order:
I) List parents, if living. If parents not living,
2) List a1\ bTQthers and sis.ters¡
3) If any brother or sister ( ied before decedent, also I.ist his or her children,
4) Ifno parent, brother or sister survived decedent,.Iist following ifany surviving: grandparents, nephews and nieces; uncles and
aunts; cousins; if none of foregoing survived, list nearest of kin surviving.
Name
Address
Date of Birth
Date ofDe.ath I Relationship to
Decedent
ATrACH ADDITIONAL PAPER IF NEEDED TO COMPLETE SECTION ABOVE
N/A
14. If land is in Olclahoma, did decedent file in County Clerk' 5 office electi
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\. ~>~ t.J rP~~b}.ND SWORN to before me this ~ day of
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Slgnature.of Affiant
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Notary Public
CORROBORATING AFFIDAVIT
State of (.0 L! () M I !-.Y.')
CountylParish oflY-t t2-J4 Hi F
(fO Ill:: SIGNED UV SOME PEIŒON OTHEH THAN
THE ONE MAKING THE FOREGOING Al< ?IDA VIT)
AFFIANT MAY NOT m: AN IŒm NAMED AUOY~:
Ca fl1p/v ,"() e. ;¿, í(,'3.f-J. Vb , oflawful age, being first duly sworn, upon h;S oath states: That the information
given in the above and foregoing affi it is true, and accurate, to the personal kno edge of this affiant.
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.:'~"::' \\. '"S\IDSCRIBED ANt) "SWORN to before me this :.l!2- day of
:: .L. : M1~~ission ~xpirf$:
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Notary Public
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