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Home My WebLink About966395AFFIDAVIT OF SURVIVORSHIP RECEIVED 8/24/2012 at 10:13 AM RECEIVING 966395 BOOK: 792 PAGE: 338 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 1, VALIER R. WARING, being first duly sworn, upon my oath depose and say: THE STATE OF WYOMING COUNTY OF LINCOLN ss. 1. That I am of adult age, a resident of Smoot, Lincoln County, Wyoming, and the Affiant herein. 2. That by virtue of conveyances which are recorded in the office of the County Clerk, Lincoln County, Wyoming, in Book 357 PR Page 285, R. Gordon Waring and Valier R. Waring, Husband and Wife, are the record owners of the following described property: That part of the SW1 /4SW1/4 of Section 32,T3IN, R118W, Lincoln County, Wyoming, being part of that tract of record in the Office of the Clerk of Lincoln County in Book 112, of Photostatic Records on page 445, as more particular described on Exhibit A attached, being a legal description prepared by Marlowe A. Scherbel, RLS 5368, dated March 29, 1994. SUBJECT to all easements, exceptions, restrictions, reservations and rights of way of sign or record. 3. Said Robert Gordon Waring died on the 8th day of August, 2011, at Denver, Denver County, Colorado, and a copy of the official certificate of his death, certified to as true and correct by the public authority in which the original of said certificate is a matter of record, is attached hereto as Exhibit "A 4. By reason of the death of said Robert Gordon Waring, and by reason of W.S. 2 -9 -102, his interest and title in said Quitclaim Deed has terminated and title to the real property conveyed thereby has vested in Valier R. Waring. 3. That among the asset owned by said decedent is the following: COMPANY 1) MV Purchasing Co. Iberia Mng Systems 1 E Greenway Plaza, Ste. 700 Houston, TX 77046 -0100 713 629 -4490 Ritchie Exploration P.O. Box 783188 Wichita, KS 67278 -3188 316- 691 -9500 2) Plains Marketing LP P.O. Box 4648 Houston, TX 77210 -4648 713- 646 -4460 Schmid Properties P.O. Box 389 Hico, TX 76457 254- 796 -2200 Oil rights /royalties Owner #9064 Oil rights /royalties Clark well FIN 750465991 Affidavit of Survivorship Waring Page 1 of 2 ACCOUNT TYPE BALANCE 5,564.29/yr Oil rights /royalties unknown Oil rights /royalties 14,555.11/yr Property owner #01- 072788 Owner #0526069 unknown 0033,8 3) Noble Energy Inc. 110 W. Broadway P.O. Box 909 Ardmore, OK 73402 -0909 4) Suncor Energy Marketing Inc. Entex Division Services 17301 W. Colfax, Ste. 406 Golden, CO 80401 5) Valero Marketing Supply Co. P.O. Box 696000 San Antonio, TX 78269 -6000 800 475 -4171 ext. 5982 6) World Petro Inc. 36700 Woodward Ave., Ste. 101 Bloomfield Hills, MI 48304 248 594 -6622 7) Enduro Operating LLC (formerly Ward Williston Oil Co.) Attn: Angela Powers 777 Main St., Ste. 800 Ft. Worth, TX 76102 817 -529 -8468 8) Alfred Ward Son Oper. P.O. Box 737 Ogallala, NE 69153 -0737 STATE OF WYOMING TOTAL ESTIMATED VALUE COUNTY OF LINCOLN WITNESS my hand and official seal. C YST,4L l_ ::;;P t NOTARY TARY PURL Gotin:y o, State of Lincoit 4 1:i�' Wyoming My Coimnics,.. o-icruary 3, 2014 ss. My Commission Expires: FURTHER AFFIANT SAYETH NOT. DATED this day of August, 2012. Affidavit of Survivorship Waring Page 2of2 Oil rights /royalties unknown Oil rights /royalties FIN 51-0403125 Oil rights /royalties Cust. ID 10111600 SS 530143038 Oil rights /royalties FIN 41- 2043867 Oil rights /royalties MRP Sherwood Unit REFNUM 00000014 RGWOO VALI ER R. WARING i NOTARIAL OFFICER unknown unknown unknown unknown 552.73/yr $20,672.13 +1- SUBSCRIB D AND SWORN to before me, a Notarial Officer, by VALIER R. WARING, this 2 day of August, 2012. 0033 I DECEDENTS NAME (First. Middle. Last) Robert Gordon 5a AGE Last Birthday (Yee 5) CERTIF ILR 6. WAS DECEDENT EVERUIN U.S. ARMED FORCES? 13 Yes No 10a. DECEDENTS USUAL OCCUPATION (Give kind work done during mostol working Ole, Do Ace use :rolired.) 13a. RESIDENCE•STATE Wyoming 13e, INSIDE CITY LIMITS? 13h. COUNTY Lincoln 131 ZIP CODE 83126 1 T. FATHER-NAME r (First, movie Lest) Robert Washington Waring 20e. METHOD OF DISPOSITION Burial 0 Cremation 0 Removal) from State r 0 Donation 0 Other(Specdy) 5b, UNDER 1 YEAR Mos Gays 9a. PLACE OF DEATH (Check only one) 9b FACILITY NAME (lr.not institution, Denver Hospice Inpatient t4. WAS DECEDENT:OF HISPANIC ORIGIN ■N oeclly Nc 0 ^Yes Ryes. ePemlY Cub�eh No. O: Yes Pu erto R I n el O Seesaw ca c) 21e, IGNATURE OF FUNERAL DIRECTOR OR PERSON i\cV NO AS SUCH 22a. REGISTRAR'S SIGNATURE` WARING I Ob. KIND OF BUSINESS /INDUSTRY Smoot 16.'MOT.HER •NAME; (Foal, Middle, LAW (Malden Name)) Leila Ann Ellis m 200. PLACE OF DISPOSITION (Name ol- ceerery,,cramatory; other place) 2. SEX Male 6c. UNDER 'i DAY 6. DATE OF BIRTH Mina (Month, Year) December 21, 1928 0 Inpatient 0 ER /Outpatient O DOA i OTHER 1 0 Nursing Hame 0 Residence Other (Specs give street and number) 9c. CITY, TOWN, OR LOCATION OF DEATH, Care Center Denver 11. MARITAL STATUS Married, Never Married, Widowed, Divorced (Speedy) Married PARENTS DISPOSITION 134. STREET AND NUMBER 77808 Highway 89 15. RACE) American Indian, :Stack, White, etc. (Speclly) Denver; CO 216: NAME AND ADDRESS OF FACILITY. Horan McConatyFuneral Service/Crematil 3101 S. Wadsworth Boulevard, Lakewood, C CAUSE or I DI A111 23. IME •7 DEATH 4 :10 26. 10 the ce the uae(a) and bast or my mann knower ledas ge,(tlaalhoccurred at the time, dale and price; 000 due to tp.. S)gnarurer► j!� �JC!� 26. DATE SIGNED 4 Month, Day, Year) 30 E A ND MAILING ADDRESS OF CERTIFIER/CORONER (Type/Prim) 0 P(I n CJ e 4' e 2-1 91: -N E OF ATTENDING HYSICI 7 IF OTHER THAN CERTIFIER (Type /Print) 33e. DATE OF INJURY. (Month, Day. Year) 33e. PLACE OF INJURY-At home, term, street, factory, oMbe guesting, etc. (Speclly)., 33,d.' DESCRIBE HOW.INJURY OCCURRED 331. LOCATION (Street end Number or Rum! Route Nu USE PER LINE FOR (a). (Dl, AND (c),) 1r Do not enter Mode of dying;. S.g. Cerdiao or Reaplretorydnwf)alone.. f to 7>C S an 04, IONS -Condll)Ons contributing to deetn but not related tD cause OF Isity, smoker). Accident 34. IMMEDIATE CAUSE )ELATE NLY NE; (a) e(0 CONDITIONS DUE TO0 AS A CONS 7QI,NCE OF IF ANY WHICH. GAVE RISE TO IMMEDIATE CAUSE DUE TO OR AS A GONSEOUENCE OF STATING THE UNDERLYING CAUSE LAST (c) (c) STATE OF COLORADO COLORADO DEPARTMENT OF PUBLIC HEALTH -AND ENVIRONMENT HOLD TO LIGHT TO VIEW. WATERMARK ER OF DEATH blural 0 Pending Investigation Suicide 0 Undetermined Manner 0 Homicide PART' OTHER SIGNIFICANT CONDI' 11 PART I le.g., 0)0060) abuse, 00 STATE OF COLORADO STATE FILE NUMBER CERTIFICATE OF DEATH TO SE COMPLETED ONLY BY t ERTIPYING PHYSICIAN DATE ISSUED AUG 1 2 2011 THIS IS A TRUE CERTIFICATION' OF NAME AND FACTS AS 1Fi RECORDED IN THIS OFFICE Do not accept unless prepared on security paper with engraved border displaying the Colorado state seal maurRS and signature of the Registrar. PENALTY BY LAW, Section 25-2-118, ff s�� Colorado Revised Statutes, 1982, if a person alters, uses, attempts to Al se or furnishes to another for deceptive use any vital statistics record. fit WO NOT. VALID IF PHOTOCOPIED. 29, DATE SIGNED. (Month; Day, Yell 3. DATE OF DEATH (Month, Day, Year) A ugust 8, 2011 T. BIRTHPLACE (City end Enda or Foreign c ountry) Los Angeles, California tq Hos toe be—COUNTY OF DEATH Depver 12 SPOUSE (II wile, give maiden name) Valier Robs E NT'�u EDUCATION ISpeCll y only highest mplead) Elementary or. secondary 11 12) College (13 through 16 or 17 19. ;INFORMANT•NAME and relationship: deceased. Varier Waring (Spouse) or 20c. LOCATION City or Town, Stale ATEFILED IMOnle,Day, Year) r AUG 1'4 2011 25; WAS CO ONER NOTIFIED? (Yes or No) Yes 70 BE COMPLETED E Y CORONER zip 80227 27. °mete bests of examination and /or investigation, ei my opinion death occurred al Ole time; date and place, and due to the mates) and manner as slated Signature RONALD S. HYMAN STATE REGISTRAR REV 01/07 r, City, County, Sate) Interval between onset' and death All V IN Interval between onset and death IS. IF:YES were f!h'dlogs con'0idered Itt deteneinin6ceute 01066th? Ali /1(r' s€ aj i CERTIFICATION OF VITAL RECORD w'r NO ST ef alp In rA A'