HomeMy WebLinkAbout957749NAME OF SPOUSE
DATE OF
MARRIAGE
LIVING /DEAD
DIVORCED
DATE OF DEATH
OR DIVORCE
WAS THERE A PROPERTY SETTLEMENT?
IF "YES" ATTACH COPY
Donna Hose
6 24 72
living
n/a
n/a
NAME OF CHILD
DATE DF
BIRTH
ADDRESS
LIVING/
DEAD
DATE OF
DEATH
BY WHICH SPOUSE
NONE
RECEIVED 1/24/2011 at
11:14 AM
STATE OF Mi sS__01
COUNTY OF T aney ss.
AFFIDAVIT OF HEIRSHIP OF
WILLIAM HAYDEN HOSE
Deceased
000192
Donald W. Ingrum
of lawful age, being first duly sworn, on oath deposes and says;
That affiant was personally and well acquainted with the above named decedent during the latter's lifetime, having known deceased for
4 years.
Decedent died atBlue Eye
1-h day of march 20 08
at the time of death.
Stone
being 7 2
County, State of Missouri on or about the
years of age, and a resident ofStone County, MO
That the following statements and answers to the following questions are based upon the personal knowledge of affiant and are true and
correct:
1. Did decedent leave a will? yes If so, has the will been admitted to probate? n0
proceedings are pending, and name and address of executor.
Give name of County and State in which such
(If decedent left a will, please attach a certified copy of same, together with a copy of the order of court admitting it to probate, and letters
testamentary.)
2. If decedent left no will, have administration proceedings been initiated? n/a
administration proceedings are pending and name and address of administrator.
3. Have ancillary probate proceedings been opened on decedent's estate? NO
If so, when? Where?
4. If no administration proceedings have been initiated, are there any plans to have the estate administered? no
5. Did decedent leave any unpaid taxes, including federal estate or state inheritance taxes or other debts?
possible the amount of such taxes or other debts, to whom owing, and whether they have since been paid
8. Marital status of decedent at time of death (married, single, divorced, widowed) married
9. If decedent was ever married, give the following information for each marriage: (List names in o der of marriage)
RECEIVING 95 7749
BOOK: 761 PAGE: 192
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
If so, give the name of the county and state in which said
ro
If so, give as nearly as
6. Was decedent surety on any bond or guarantor of any other person's indebtedness at time of death? no If so, give details as to
principal debtor, amount, etc.
7. Were there any suits pending or judgments rendered against decedent at time of death? no If so, state briefly the nature, amount and
parties involved
10. If decedent had any children by any spouse, or adopted any children, give the following information: (attach separate sheet if necessar
k: \heirship.aff
04/2003
DESCRIPTION
NAME OF CHILD
DATE OF BIRTH
ADDRESS
LIVING /DEAD
DATE OF DEATH
in n n
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attachcd
NAME OF CHILD
NAME OF CHILD
DESCRIPTION
DATE
ACQUIRED
FROM WHOM?
HOW ACQUIRED
(GIFT, PURCHASE,
INHERITANCE)
IF ACQUIRED BY PURCHASE, WERE FUNDS USED
THOSE OF DECEDENT ONLY OR COMMUNITY
PROPERTY FUNDS WITH SPOUSE?
See— B-sk r ti r vim
in n n
un14nF#wn
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Liriknc wn
attachcd
11. If a deceased child left descendants, give the following information: hi a
12. If decedent left no children or descendants of deceased children, then please furnish the following information:
a. Give names of parents of decedent:
ADDRESS
LIVING /DEAD
NAME
b. Give names of brothers and sisters of decedent:
RELATION
ADDRESS
LIVING /DEAD
NAME
c. Give names of children of deceased brother or sister:
CHILD OF
DATE OF BIRTH
ADDRESS
NAME OF CHILD
13. If decedent left no heirs covered by Item 12 above, then attach a full and complete affidavit of heirship of said decedent in narrative form.
14. Give location or description of homestead of decedent as of date of death:
15. As to each tract of land or interest in land owned by the decedent at the time of death which concerns this company, give the following
information which will be used primarily for the purpose of determining whether property was separate or community: (If space provided is
insufficient, attach exhibit giving same information as to each tract.)
16. Briefly state facts and circumstances (such as being a relative, a close friend, or attorney or agent for decedent) which will show basis and
source of information given above. attorney
Subscribed and sworn to before me this
My commission expires:
STATE OF
COUNTY OF
.Nl165ou.rl
Taney
Subscribed and sworn to before me this
My col.: .expires:
NOTAR
SEAL
fir
1M
THERESA L SAINATO
My Commission Expires
April 6, 2013
Taney County
Commission #09768587
day of
SUPPORTING AFFIDAVIT
*L s f
AFFIANT Donald W. grum
P.O. Box 1105, Branson, MO 65615
ADDRESS
Y ar
NOTAR
k 1 y R iG n of lawful age, being first duly sworn, on oath states: �1
That h was per onally and well acquainted with W/IWi dliaYrt J� den KA ring ,2)I. 1
lifetime; that 6h has read the above affidavit by DOh Id VA/. n jruO and. that the fasts s at d then in are true and correct.
AFFIANT
NOTARY PUBLIC
,2011
KAY ALLEN
Notary_ P�NC Nosy Seal
5taoe of Missouri
My Commissioned for Taney County
0
Commission N mbec 55 14
DATE OF DEATH
DATE OF DEATH
LIVING /DEAD
Township 22 North, Range 94 West
Section 22: All
Section 23: W2SWNW, W2NWSW
All located in Sweetwater County, WY
Township 23 North, Range 112 West
Section 31: SWNE
All located in Lincoln County, WY
EXHIBIT A
Attached to and made a part of that Affidavit of Heirship
for Wiliam H. Hose
000194