HomeMy WebLinkAbout973508STATE OF TEXAS
COUNTY OF HARRIS
Wage
Not Applicable
PROOF OF DE. 4T.9C. D 3-fTIRS3(IP
[Legal Description Attached]
This Affidavit must be completed by a disinterested third -party (Affiant) who will not benefit from the decedent's estate. Do not
complete this form if either probate or ancillary probate has been conducted the state where the property is located, or if there
has been some other type of court determination in this state. This Affidavit must be recorded t the county in that the property
to be transferred if located. If any section requires additional space, please attach a separate piece of paper.
I, John A. Wells, being of lawful age and duly sworn, state:
1. That the statements hereinafter set forth, including answers to questions, constitute a true,
correct and complete statement of the family history of the person hereinafter named as
"decedent" and if the estate of such decedent.
2. Name of decedent: Donnell O. Wells a /k /a Donnell O. Wells
3. Date of death: February 9, 2013
4. Was the decedent married or single? Single
5. If the decedent was married one of more times, give the following information (list names in
order of marriage): Not Applicable
6. If decedent had any children by any spouse, give the following information:
NAME OF CHILD ADDRESS AGE CHILD'S MOTHER DECEASED?
(If yes, date)
Thomas Donnell Wells 2300 S. Fairfax Dr. 59 Connie Lichty Smith N/A
Denver, Co 80222
Brian Edward Wells 2964 So. Newport St. 55 Connie Lichty Smith N/A
Denver, CO 80224
7. If decedent had any children by adoption, give the following information: None.
RECEIVED 9/30/2013 at 2:52 PM
RECEIVING 973508
BOOK: 821 PAGE: 486
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0486
2/Page
0487
8. If any of the above named children have died, please list their children, both natural and
adopted: Not Applicable
9. If the decedent left no surviving children or children of deceased children, give the
following information: Not Applicable
Further affiant saith not.
Subscribed and sworn to before me this "1 to day of
My commission expires:
ABBY LOUDER
My Commission Expires
May 3. 2016
Signature of A y! nt, John A.
2013
Notary Public
Notary public residing at:
'-1-tat 4 L'DU
Legal Description 0488
Tract 29 Township 26 North, Range 113 West, 6th P.M.
Section 15: S
Containing 320.00 acres
Lincoln County, Wyoming
EOG Resources
FED LEASE: WYW 066369