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Home My WebLink About960564Name of Spouse �}nJLG� ti 8 i h K Date of Marriage q 7 3 L_-lying/Dead 7 L /�f�l Divorced 2,3 b y Date of Death or Divorce Was there a property settlement? If "Yes attach copy. b �j y ltrlt'?'K'fZS 1 ^b }i.�/1.1 /.u.cu .Lti.n•-aw- *IL, 13r1 *IS. i T'4e, ..1 GQIc�.; P.L. /'q I'�' .c. /l.�ln e t EI.ii c 5 ri nk °3 1 6.7 Iig31 3cin gLectii) ied Name of Child Date of Birth Address Living /Dead Date of Death By Which Spouse j 13r1 *IS. i T'4e, ..1 GQIc�.; P.L. /'q I'�' .c. /l.�ln e t EI.ii c 5 ri nk °3 1 6.7 Iig31 3cin gLectii) ied 8 ree. >Lsb,... t e A fVi 1v' U.: AFFIDAVIT OF HEIRSHIP OF STATE OF C..v /0 COUNTY OF Ave f f Cs k c— correct: 'et r L( 1 I n SS. 2. 0 decedent left no will, have administration proceedings been started? Deceased 000225 LIq Q f "I\ 5A 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 years. f` Decedent died at Aa■PR�a31-1c: County, State of CC On or about the ld day of 1'n /-1 y 20 c 9 being L %;d years of age, and a resident of at the time of death. That the following statements and answers to the following questions are based upon the personal knowledge of affiant and are true and 1. Did decedent leave a will? e S If so, has the will be admitted to probate y C Give name of County and State in which such proceedings are pending, and name and address of executor. (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.) 04 z� said administration proceedings are pending and name and address of administrator. r c L AQf /1,4 6lc e e e k f e i c o rcx /'lA r 1L 1 1 3. Have ancillary probate proceedings been had on decedent's estate? 0 so, when? Where? 34 e If so, give the name of the county and state in which r 4. If no administration proceedings have been started, are there any plans to have the estate administrated? A-. 5. Did decedent leave, any unpaid taxes, including federal estate or state inheritance taxes or other debts? If so, give as nearly as possible, the amount of such taxes or other debts, to whom owing, and whether they have since been paid 6. Was decedent surety on any bond or guarantor of any other person's indebtedness at time of death? e 0 so, give details as to principal debtor, amount, etc. 7. Were there any suits pending or judgments rendered against decedent at time of death? If so, state briefly the nature, amount involved and parties 8. Marital Status of Decedent at Time of Death (Married, Single, Divorced, Widow, Widower) Lt) I C E?Lo 9. 0 decedent was ever married, give the following information for each marriage (List names in order of marriage) 10. If decedent had any children by any spouse, or adopted any children, give the following information: FORM 540 RECEIVED 8/15/2011 at 10:49 AM RECEIVING 960564 BOOK: 771 PAGE: JEANNE WAGNL. Description Date acquired From Whom? State How Acquired (Gift, Purchase Inheritance or Under a Will) If acquired by Purchase, were funds used those of decedent only or community property funds with spouse? 000226 11. If a deceased child left descendents, give the following information: Name of deceased child Name of deceased child Name of Child Date of Birth Address Living /Dead Date of Death 12. If decedent left no children or descendents of deceased children, then please furnish the following information: a. Give names of parents of decedent: Name Father Mother Address Living /Dead Date of Death b. Give names of brothers and sisters of decedent: Name Relation Address Living /Dead Date of Death c. Give names of children of deceased brother or sister. Name of Child Child of Date of birth Address Living /Dead 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 and or interest in and owned by the decedent at the time of his death which concerns this company, give the following information which wil 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. Here briefly state facts and circumstances (such as being a relative, a close friend, or attorney or agent for, decedent) which wit show basis and source of information given above. Subscribed and sworn to before me this My comrission expires STATE OF M Ef COUNTY OF 5 s•r rte That FOAM 540 tieie e .S 3 rj1%1c My commission expires c� 13 JtLD 'S 4SUPPORTING AFFIDAVIT of lawful age, being first duly sworn, on oath states: Affiant Address day of 20 1 13 1 c cue Notary Public NORMA DESROCLI!ERS Notary Public Notary Seal STATE OF MISSOURI 08484567 M Commission E Fe 13 2012 dur YP.i lifetime; That 4 y r %Q..,.S &:,n1 c. has read the above affidavit by -7( rirfuct e E 13%,r -.t( and that the fa is s t° t rein are true and correct. C Affiant Subscribed and sworn to before me this day of _k_ t 20 was personally and well acquainted with G et-1714J NORMA DESROCHERS Notary Public Notary Seal STATE OF MISSOURI 08484567 Commission E ires Fe 13, 201 Notary Public TRANSFER SCHEDULE 'A' Effective Date: 01/01/2009 Date of Transfer: 02/04/2009 Owner: 8040111 TRANSFEROR GERTRUDE BRINK Int. Shown Below Owner: 8085438 TaxID: REQUIRED Owner: 8085439 TaxID: REQUIRED TRANSFEREE RICHARD A BRINK 8432 SW 109TH LANE ROAD OCALA FL 34481 UNITED STATES EUGENE S BRINK 390 QUAIL RD BRANSON MO 65616 -9221 UNITED STATES �,Gj it Page 1 000227 02503MAL Alloc. 0.50000000 0.50000000 Property /DOI: 008084/00001 Property Name: SHUTE CREEK FRONTIER "B" State: WY County: LINCOLN Operator::BP AMERICA PRODUCTION CO Legal Description: PRIMARY DESCRIPTION; 22N -112W, 6TH PM, SEC 1: LOTS 5(40.00), 6 (40.02) 7(40.02), 8 (40.04) S/2 N /2, S /2; SEC 2: SE /4 NE /4, E/2 SE /4; SEC 11: E/2 NE /4, NE /4 SE /4; SEC 12: N /2, N/2 S /2, S/2 SW /4, SW /4 SE/ Tract Participation Factor: None Owner Owner Owner Name Interest Decimal No. Interest Type Sequence 8040111 1 GERTRUDE BRINK OR 0.00086010 8085438 1 RICHARD A BRINK OR 0.00043005 8085439 1 EUGENE S BRINK OR 0.00043005 Property /DOI: 008084/00002 Property Name: SHUTE CREEK FRONTIER "B" State: WY County: LINCOLN Operator::BP AMERICA PRODUCTION CO Legal Description: PRIMARY DESCRIPTION; 22N -112W, 6TH PM, SEC 1: LOTS 5(40.00), 6(40.02), 7(40.02), 8(40.04), S/2 N /2, S /2; SEC 2: SE /4 NE /4, E/2 SE /4; SEC 11: E/2 NE /4, NE /4 SE /4; SEC 12: N /2, N/2 S /2, S/2 SW /4, SW /4 SE/ Tract Participation Factor: None Owner Owner Owner Name Interest Decimal No. Interest Type Sequence 8040111 1 GERTRUDE BRINK OR 0.00086010 8085438 1 RICHARD A BRINK OR 0.00043005 8085439 1 EUGENE S BRINK OR 0.00043005