HomeMy WebLinkAbout968546After recording return to:
William M. Case
PO BOX 1953
Vancouver, WA 98668
0069
{00097969;1
AFFIDAVIT OF HEIRSHIP
RECEIVED 12/17/2012 at 10:54 AM
RECEIVING 968546
BOOK: 800 PAGE: 697
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
INFORMATION CONCERNING EDWARD PATRICK CASE, DECEDENT.
I, DENISE R. CASE (affiant) being of lawful age, being first duly sworn, upon oath
deposes and says:
That I was personally well acquainted with the above named decedent, during his
lifetime, having known him for 33 years, and that affiant bears the following relationship to said
decedent, to wit (state relationship to decedent): NIECE.
1. Said decedent departed this life at 5:16 PM in BERNALILLO County, State of
NEW MEXICO, on or about JUNE 30, 2012 day, being 58 years old at the date of his
death.
2. Said Decedent owned, at the time of his death, A ROYALTY INTEREST IN the land
situated in LINCOLN County, State of WYOMING, described as:
GREEN RIVER BEND UNIT FRONTIER PARTICIPATING AREA A -B
TRACTS 10 AND 10A
FEDERAL OIL AND GAS LEASES USA WYE- 025440 AND USA WYE- 025440-
A
TOWNSHIP 27 NORTH, RANGE 112 WEST, 6 P.M.
SECTION 18: S2NE, SE
SECTION 19: E2
LINCOLN COUNTY, WYOMING
GREEN RIVER BEND PROSPECT
3. The land described above WAS NOT occupied as the homestead of the deceased.
4. The land described above IS NOT now occupied as homestead of deceased's surviving
wife.
5. The land described above IS NOT community property.
6. How did deceased acquire such interest? INHERITANCE. (deed, devise, inheritance or
gift).
Affiant further states that affiant was well acquainted with the family and near relatives of the
said decedent, and the following statements and the answers to the following questions are based
upon the personal knowledge of affiant and are true and correct:
1. Did decedent leave a Will? NO. (If so, attach a certified copy thereof.)
Page 1 of 4
Name
Name
Date of Birth
Date of Death
Surviving Spouse
Address
Surviving Spouse Address
Childs
Other
Parent
Date of
Birth
N/A
N/A
N/A
N/A
N/A
Name
Date of Birth
Date of Death
Surviving Spouse
Surviving Spouse Address
N/A
N/A
N/A
N/A
11. Give below the names of any deceased children of decedent: NONE.
{00097969;1}
Page 2 of 4
00698
2. Where was Will first admitted to probate? Give name of court, and also of the city,
county, and state in which court is located: NOT APPLICABLE.
3. Has Will been probated or admitted to record in the state where the above described land
is situated? NO If so, give date, name of court and county. NOT APPLICABLE.
4. Is administration pending on the estate of decedent? NO.
If so, in what court, county /parish and state? NOT APPLICABLE.
5. Has an executor or administrator been appointed for the estate of the decedent? NO
If so, give his /her name and address. NOT APPLICABLE.
6. What is the present condition of the administration? (Answer this question regardless of
whether or not decedent left a Will NONE. DECEDENT DIED INTESTATE AND
NO ADMINISTRATION IS PENDING.
Has administration been completed? N /A. If so, has final order or decree of distribution
been rendered by the Court? N /A.
7. Were you acquainted with decedent's business affairs? NO Did decedent leave any
debts or obligations unpaid? UNKNOWN. Have all such debts or obligations been
paid? UNKNOWN. If not, how much remains unpaid? UNKNOWN. What is reason
these debts have not been paid? UNKNOWN.
Note: If decedent left a Will, but said Will was NOT probated, the laws of Intestate Descent and
Distribution will apply, and .NOT the terms of the Will.
INFORMATION CONCERNING HEIRS OF DECEDENT
8. Did decedent leave a surviving wife or husband? NO.
If so, give name address: NOT APPLICABLE.
Date of marriage: EXACT DATE NOT KNOWN; APPROXIMATELY 1974. If not
living, give date of death: EXACT DATE NOT KNOWN; 1975 OR 1976.
9. If the decedent was married more than once, give name or names of former spouse or
spouses, and state whether any such former spouse is dead or divorced, together with the
date of death or divorce: NOT APPLICABLE.
10. Give following information concerning all children born to decedent (legitimate or
illegitimate), or legally adopted children of decedent, who were living at the time of
decedent's death. NONE.
Name
Name
Address
Date of
Birth
Date of
Birth
Date of Death
Relationship to
Decedent
William M. Case
N/A
PO BOX 1953
Vancouver, WA 98668
08/19/1948
N/A
Living Brother
N/A
12. Give below the names of the living children of any deceased son or daughter (those listed
above in Item #11) of the decedent: NONE.
IF DECEDENT LEFT SURVIVING SPOUSE OR CHILDREN, THEN ITEM #13
BELOW MAY BE DISREGARDED PROCEED TO ITEM #14
13. If decedent left no surviving spouse or children, give the following information in the
following order:
1) List parents, if living. NONE. If parents not living,
2) List all brothers and sisters SEE BELOW;
3) If any brother or sister died before decedent, also list his or her children.
4) If no parent, brother or sister survived decedent, list following if any surviving:
grandparents, nephews and nieces; uncles and aunts; cousins; if none of foregoing
survived, list nearest of kin surviving.
14. If land is in Oklahoma, did decedent file in County Clerk's office election to come under
the Community Property Act? NIA.
STATE OF OREGON
COUNTY OF MULTNOMAH
The foregoing instrument was acknowledged before me this /Q day of
dew 2012, by DENISE R. CASE.
OFFICIAL SEAL
DEBORAH A BAKER
NOTARY PUBUC OREGON
COMMISSION NO. 465486
MY COMMISSION EXPIRES FEBRUARY 17, 2016
[Seal or stamp]
{00097969;1}
Denise R. Case
)ss
Page 3 of 4
0069
Notary Public fo Oregon
Printed Name: Delao rte, ,4 gq..k rr
My Commission Expires: CebeKarti 111 za 1 t'
Name
Date of
Birth
Name of Mother or
Father from item 11
above
Address
N/A
N/A
N/A
N/A
12. Give below the names of the living children of any deceased son or daughter (those listed
above in Item #11) of the decedent: NONE.
IF DECEDENT LEFT SURVIVING SPOUSE OR CHILDREN, THEN ITEM #13
BELOW MAY BE DISREGARDED PROCEED TO ITEM #14
13. If decedent left no surviving spouse or children, give the following information in the
following order:
1) List parents, if living. NONE. If parents not living,
2) List all brothers and sisters SEE BELOW;
3) If any brother or sister died before decedent, also list his or her children.
4) If no parent, brother or sister survived decedent, list following if any surviving:
grandparents, nephews and nieces; uncles and aunts; cousins; if none of foregoing
survived, list nearest of kin surviving.
14. If land is in Oklahoma, did decedent file in County Clerk's office election to come under
the Community Property Act? NIA.
STATE OF OREGON
COUNTY OF MULTNOMAH
The foregoing instrument was acknowledged before me this /Q day of
dew 2012, by DENISE R. CASE.
OFFICIAL SEAL
DEBORAH A BAKER
NOTARY PUBUC OREGON
COMMISSION NO. 465486
MY COMMISSION EXPIRES FEBRUARY 17, 2016
[Seal or stamp]
{00097969;1}
Denise R. Case
)ss
Page 3 of 4
0069
Notary Public fo Oregon
Printed Name: Delao rte, ,4 gq..k rr
My Commission Expires: CebeKarti 111 za 1 t'
CORROBORATING AFFIDAVIT (TO BE SIGNED BY SOME PERSON OTHER
THAN THE ONE MAKING THE FOREGOING
AFFIDAVIT) AFFIANT MAY NOT BE AN HEIR
NAMED ABOVE)
STATE OF WASHINGTON
)ss
COUNTY OF CLARK
GWENDOLYN M. CASE, of lawful age, being first duly sworn, upon his oath states: That the
information given in the above and foregoing affidavit is true, and accurate, to the personal
knowledge of this affiant.
I certify that I know or have satisfactory evidence that GWENDOLYN M. CASE is the person
who appeared before me, and said person acknowledged that she signed this instrument and
acknowledged it to be her free and voluntary act for the uses and purposes mentioned in the
instrument.
=Q
Uj
(Seal
{00097969;1}
Dated: 1 1 1 1
o omillimull o
S \ON E
i
(i)0 r 4 76
Gwendolyn M. Case
(Signature)
u I o,21
Title QQ
My appointment expires: 1" 1.6 2/d /to
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