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Home My WebLink About978477Y. Y State of Colorado )ss. County of Douglas AFFIDAVIT OF SURVIVORSHIP 978477 9/22/2014 10:29 AM LINCOLN COUNTY FEES: $39.00 PAGE 1 OF 5 BOOK: 839 PAGE: 839 AFFIDAVIT JEANNE WAGNER, LINCOLN COUNTY CLERK f 11 11 I, Janice M. Rickard, of lawful age, being first duly sworn upon oath, depose and state as follows: 1. This affiant is the surviving spouse and joint tenant of Owen L. Rickard, also known as Owen Lewis Rickard, deceased, and that this affiant and Owen L. Rickard were married until the death of Owen L. Rickard on March 25, 2013. 2. Said decedent died in the County of Douglas, State of Colorado on March 25, 2013, which fact of death is corroborated by the State of Colorado Certificate of Death, duly certified by the State Registrar of Vital Statistics, State of Colorado Department of Public Health and Environment, which certificate is attached hereto which certificate is attached hereto as Exhibit "A 3. This affiant and decedent acquired by a document dated March 19, 2005, entitled Assignment of Overriding Royalty "Assignment attached hereto as Exhibit `B all of the oil, gas and other hydrocarbon substance interests described therein for interests identified on Exhibit "A" of the attached Assignment. The Assignment was recorded on March 31, 2005 in Book 582, Pages 29 -31 as Receiving# 907368 in the office of the Clerk Recorder, Lincoln County, Wyoming. 4. That by reason of the death of said decedent and the status of the parties on the date of said deed and the continuation of such status until the death of the decedent, the estate in joint tenancy was terminated on March 25, 2013, and this affiant is now the sole owner of said real property interest. 5. This affidavit is made for the purpose of furnishing a recordable document showing the termination of the estate and the ownership of said property interest in affiant. Dated this S ri day of 1 2014. nice M. Rickard, Affiant Before me appeared Janice M. Rickard and being first duly sworn by me upon his oath says that the facts alleged in the foregoing instrument are true. T V Dated this /S day of IU/ -L/ 2014. MY COMMISSION EXPIRES:N My commission expires: September 22, 2014 i DECEDENTS NAME (First; :Mlddle;.Last) Owen, Lewls; 4 SOCIALSECURnv.NUMBER 5a 'AGE (Years) 70 17 FATHER _NAME (Fast Midclie, l a0) wen'Ancel RICKARD Illrlr gf� \fv'ti \��v� t li 75 1rnn i J S� §Nh��' 1 4441 i r fr t J r ib� t i lot! f f a 1s df lSl 18 s/s /i L taoS rsfl 1i �SSS �'tlhn jA O� 5 rr �S 1 s 1S n 5 ICAIONO.FV�TALREC.,QR CERTIF COLORADO DEPARTMENTOFPUs'LIC WEALTH AND ENVIRONMENT HOLD TO LIGHT TO'VIEW WATERMARK STATE OF COLORADO CERTIFICATE OF DEATH. EO1.DEATH 24.' ATE AND TIME P Month 'gam PM Mtft si Maroh 5b. UNDER 1 YEAR 8 WAS EVER 9a. PLACE OF DEATH (Check only one) iN b S.ARMED FORCES? HOSPITAL: s .Q.Yes No Q:inpatient ER/Oumatient Q DOA 9b FACILITY NAME (It net mst(tulton;. give street and number) Parker, Adventist Hospital 1 DECEDENT'S USUAL OCCUPATION (Give kiild of Ob. tIND OF BUSIN donedunng most o(wodag rde_ Do NOT(se ret Land,Man Od Gas 29 :MANNER OFDEATH Nettua 0Acadent EtSwcid D Homicide: 0 Pending Invesbgabon DUndetermeted .32.1= tAItUFINJURY(Month, ear)32b..T1ME TO BE: COMPLETED. BY SIGNING PHYSICIAN 26a. Tothebestofrr yinowledge, date place, and due to the catse(s) manner ature •:e e or rl 26b,PATESIGNED (Monts Day Year) Y 3 /o2 (0%ZO I 26c. NAM yinAH NG ADDJ ESS OF SIGNING PHYSICIAN ►rJ pe you /e [7131 5c. UNDER £1'DAY OTHER: Asslsteduvittgif4l Home. fl hospice Q Other (Specify), 9c. CITY, TOWN, OR LOCATION OFDEATH Parker 13a. RESIDENCE TAI t 13b. COUNTY 3a CRY TOWN .0171 LOCATION 3d:STREETAND NUMBER Douglas Parker 12935 Piney Lake Road. 13f ZIP CODE 14. WAS DECEDENT OF HISPANIC ORIGIN?... lf specify ubenMaadoen Puerto Kwon etc 80138 Na ❑Yes Speedy 5.. 9INFORAAMlr -.NAME andmlationship to deceased J anice Marie RICKARD 4Vife 20a METHOD OF DISPOSmON. p Rev:nation" 20b. PLACE'OF DISPOSITION (Name 0t<cemetery, crematory, orother 200: LOCATION -City orTatn, Slate D naifEntombmentr q,Cremation QRemovarfrein State P BU 10Cnatlon arke Crematory 21aSIGNAIUREOF. FUN D IRECTOR OR PERSON ACTING ASSl1CH 11 M4RIUU-S1JUUS 12, SPOUSE (If wrfe give. maiden name) sorted lJNeviorMamed Widowed Q Drvdlced ur lmmm. Janice Mane rker CO 21b.N AN AMED:ADDRESSOF* Y P ARKER FUNERAL HOME INC 10325 PAI?kGLENN WAY PARKER, CO 80138 31. IF FEJIALE: D Notpregnant within lastyear:. }regrrwitattima at death ❑Notpiegraht, butprageardwdtiyt 42 daysotileath 32c. INJURY AT WORK? 32d. DESCRIBE HOW INJURY. OCCURRED D; AM DPM D Mitt I] YeS: 2e. PLACE.OF INJURY' home, tatrn, street, factory oninetwllding etc. (Specify) 321 LOCATION INJURED (Streetend Numberer Rural Route Number Ctly, County, State) :2-SEX Male 3 3 IMMEDIATE CAUSE- enter only one c a u s e per line f o r a b and c Do not enter mode of dying (e g. Cardiac or Respiratory Arrest) alone. Pa (a +Tr�•-P 4 C'l `i-kei I C ST1�1.p(C Cart )'I)arry DUETOOR AS ACONSEQUERCE OP., Which gave nse to immediate oaaSetati,nalrie (b) 14}/Pei--Fe4t5 I o''L! Undeflyltlg DUEtrcOttOR ASACONSEOUENGEOF:: last (c) (a) Part g OTHER SIGNIFICANT CONDmONS- Conditions contributing to death but not related to cause In Part :I DAT MAR 26 2O13 THIS'S ATRUE CERTIFICA ION OF NAME AND AS RECORDED IN THIS OFFICE. Do not accept unless prepared on security•paper with. engraved bor. .der. displayipg the Colorado state seal., and signatuve of the Registrar PENALTY BY LAW Section 25 118, Colorado Revis&1 Statutes, 1982, 4 petson'altels, uses, attempts to... use or furnishes to another for deceptive use' any vital statistics record. NOT VALID IF::PHOTOCOPIED. 7. BIRTH PLACE (city and Gtarte or Foreign Country) Kemmerer, WY. DATE FILED (Month;'Day,Year); TO BE'COMPLETEU BY Z7a On trick basis df tex nimatitn and/orhwestfgabon, in tryopeeon death ocdmed at the time, date and place, and d tote cause(s) and 'limner as stated 0 Coroner D Assocmeput Coroner: 276. DATE SIGNER:: (Month, Day, Year) 27o.NAMEAND COUNTY 28 NAME OF ATTR4DINGPHYSICIAN wgr. niERTHAN SIGNING PHYSICIAN 'RONALD S HYMN REGISTRAR STATE FILE NUMBER;:. 3,, DATE OF DEATH:(Month; Day, Year)), March 25., 2013 0 Not pregnant, tut pregnant 44day5.to 1 year before death D Unlmown i1 pregnant wthin the past year Interval between Interval between onset and death (Oecce>s 35. YES, were findings considered In detednlning cause of death? El 5Yes No land death THE UNDERSIGNED, O. L. RICKARD, 12935 NORTH PINEY LAKE ROAD, PARKER, COLORADO 80138, WHETHER ONE OR MORE COLLECTIVELY DESIGNATED HEREIN AS ASSIGNOR, FOR VALUE RECEIVED, DOES HEREBY ASSIGN, TRANSFER CONVEY, AND SET OVER UNTO: OWEN L. RICKARD AND JANICE M. RICKARD AS JOINT TENANTS, WITH RIGHT OF SURVIVORSHIP, 12935 NORTH PINEY LAKE ROAD, PARKER, COLORADO 80138 ASSIGNEE'S ALL OF ASSIGNOR'S RIGHT,'11'1'LE, AND INTEREST IN ALL OF THE OIL, GAS, AND OTHER HYDROCARBON SUBSTANCES PRODUCED, SAVED AND MARKETED FROM THE LANDS HEREINAFTER DESCRIBED UNDER THE TERMS OF THE OIL AND GAS LEASES, HEREINAFTER SPECIFIED AS SET FORTH IN DETAIL ON THE EXHIBIT WHICH IS MARKED EXIIIBIT "A" AND ATTACHED HERETO. THOSE CERTAIN OIL AND GAS LEASES DESCRIBED ON EXHIBIT "A" RUN TO THE ABOVE NAMED ASSIGNEE'S INDIVIDUALLY AND TO THE HEIRS, SUCCESSORS AND ASSIGNS OF THE ASSIGNEE'S. EFFECTIVE JUNE 1, 2005 LINCOLN COUNTY, WYOMING THE INTERESTS HEREBY CONVEYED ARE FREE OF ALL COST AND EXPENSE EXCEPT SERVERANCE AND PRODUCTION TAXES, INCLUDING WINDFALL PROFIT TAXES, AND OTHER TAXES LEVIED AND ASSESSED UPON THE OVERRIDING ROYALTY SHARE OF PRODUCTION HEREBY ASSIGNED, AND SHALL BE ACCOUNTED FOR AND PAID FOR ON A MONTHLY BASIS. IF THE ASSIGNEE DOES NOT ELECT TO TAKE IN KIND HIS PROPORTIONATE SHARE OF THE OIL OR GAS AFFECTED BY THIS ASSIGNMENT THEN THE ASSIGNOR OR ANY OTHER OPERATOR 0I SAID LEASE SHALL SELL SUCH ROYALTY OIL AND /OR GAS AT A PROCE NOT LESS THAN THE BEST AVAILABLE COMPETITIVE PRICE FOR SAME AND CAUSE THE PURCHASER THEREOF TO MAKE DIRECT PAYMENT TO ASSIGNEE. THIS OVERRIDING ROYALLTY CONVEYED BY ASSIGNOR AND ACCEPTED BY THE ASSIGNEE'S SUBJECT TO THE TERMS OF THE OIL AND GAS LEASES, OPERATING AGREEMENTS, COMMUNITIZATION AGREEMENTS POOLING AGREEMENTS, AND ALL OTHER CONTRACTS BINDING UPON SAID LEASES. THESE ASSIGNMENTYS SHALL COVER ALL LEASES ISSUED AS EXTENSIONS, OR RENEWALS OF THE ATTACHED REFERENCED LEASES, AND LEASES ISSUED AS A SUBSTITUE FOR SAME. no (L.,:' COUNTY OF ��N V 0 L"' REDOING N WAS ACKNOWLEDGED BEFORE ME BY L (Gl� +g� i ce T D 11' OF J�'J 2005 IN WITNESS WHEREOF, THIS DOCUMENT IS EXECUTED THIS DAY OF *OL ,2005. 3y `Y W I:NESS :MY HAND AND OFFICIAL SEAL. MY COMMISSION EXPIRES: ASSIGNMENT OF OVERRIDING ROYALTY 0. L. RICKARD r Z n m 0 0 73 n z O O mm 8 z G) w m 0 y D® cnn z tJ Cn m D x m :Il EXHIBIT "A" W -8713 T. 25 N., R: 111 W. 10/1/1967 SEC. 7:. LOTS 7,8,9,10 LINCOLN CO. CONTAINING 155.22 ACRES W -26856 T. 25 N., R. 111 W. 1/1/1971 SEC. 6: LOTS 8,9,11,12,14,15 LINCOLN CO. CONTAINING 233.67 ACRES W -31975 T. 25 N., R. 112 W. 12/1/1971 SEC. 10: ALL LINCOLN CO. SEC. 11: ALL CONTAINING 1280.00 ACRES W -33552 T. 25 N., R. 112 W. 3/1/1972 SEO. 1: LOTS 1,2,3,4, W1/2E1/2, W1 /2 LINCOLN CO. SEp. 2: E1 /2 CONTAINING 957.72 ACRES W -33554 T. 26 N., R. 112 W. 3/1/1972 SEC. 35: NW1 /4 LINCOLN CO. CONTAINING 160.00 ACRES W- 0311651 T. 25 N., R. 112 W. 10/1/1964 SEC. 12: LOTS 1,2,3,4, W1/2E1/2, W1/2 LINCOLN CO. SEC. 13: LOTS 1,2,3,4, W1/2E1/2, W1 /2 CONTAINING 1267.52 ACRES W- 0311651 -A T. 25 N., R. 112 W. 10/1/1964 SEC. 14: ALL LINCOLN CO. SEC. 15: ALL CONTAINING 1280.00 ACRES W -10611 T. 26 N., R. 112 W. 2/1/1968 SEC. 1: LOTS 1 THRU 7, SW1 /4NE1 /4, LINCOLN CO. S1/2NW1/4, SW1 /4, W1/2SE1/4 CONTAINING 650.19 ACRES W -15744 T. 26 N., R. 111 W. 11/1/1968 SEC. 18: LOTS 1,2, E1/2NW1/4 LINCOLN CO. CONTAINING 149.24 ACRES 0030 WJ -20 T. 5/16/1968 SE LINCOLN CO. BRUCE E. JONES, ET UX RECORDED BOOK 84PR PAGE 23 WJ -21 T. 5/16/1968 SE LINCOLN CO. T. BRUCE E. SE ET UX RECORDED SE 84PR PAGE 21 EXHIBIT "A" 25 N., R. 112 W. C. 7: SE1 /4SE1/4 SEC. 8: LOTS 3,6,7 SEC. 17: W1/2W1/2, SE1 /4SW1 /4, LOTS 2, LOTS 3,6 SEC. 18: E1/2E1/2 SEC. 19: E1 /2NE1 /4, NE1 /4SE1 /4 SEC. 20: W1 /2W1 /2, LOTS 2,5,9,10, NW1 /4SE1/4 SEC. 21: LOT 1 SEC. 28: LOTS 3,4,5,6,7 SEC. 29: LOTS 1,2,7, NW1 /4NW1 /4 25 N., R. 112 W. C. 5: LOTS 2,3 26 N., R. 112 W. EC. 32: NE1 /4, N1 /2SE1 /4, SW1 /4SE1 /4, LOT 1 EC. 33: W1 /2NE1 /4, LOTS 4,5,8 WM -64 T. 25 N., R. 112 W. 5/17/1968 SEC. 5: NW1 /4SE1 /4,LOTS 9, 13 LINCOLN CO. SEC. 8: NE1 /4NW1 /4, LOT 1 JOHN E. MARX ET UX RECORDED BOOK 84PR PAGE 86 N., R. 112 W. 8: LOTS 4,5,8 17: LOT 1, NW1 /4NE1 /4 WH -64 T. 25 6/10/1968 SEC. LINCOLN CO. SEC, WARREN E. HARMISON, ET UX RECORDED BOOK 84PR PAGE 272 W -796 T. 26 N., R :111 W. 9/1/1966 SEC. 30: LOTS 3,4, E1 /2SW1 /4 LINCOLN CO. CONTAINING 153.12 ACRES 66 -11198 T. 26 N., R. 112 W. 7/2/1966 SEC. 36: ALL LINCOLN CO. CONTAINING 640.00 PLUS OR MINUS ACRES 003.