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HomeMy WebLinkAbout888566EXACO EXPLORATION AND PRODUCTION INC · O. Box48~13 enver, Colorldo 80201-8~13 NOTICE: HEIRSHIP AFFIDAVIT RECEIVED LINCOLN COUNTY CLERK Thl= affidavit MUST be sworn to before a Notary Pu'bllc. [Please print legibly or type.] BOOK ,.~1 c- ~PR ~AO: 309 HEIRSHIP OF O~Y~'g~N~_ ~, ?),~L,~L~)~ 1. DECEDENT WILL/PROBATE 3. ESTATE ADMINISTRATION AdE ,~l~ DEATH (~,...~ YEAR S Did decedent leave e vail? I2[..YE S riND Is this the decedent's separate or community Property? ,I~.,YE S []NO Has aomeone been appointed to administer ihe eslala? [] YES Il' YES, has will bean admitted lo probate? CZ. NO .~Separate []Communtty. ~ ~ , ,. ;.. ;~ ...-: i "~' ..... :!r?~,~::""~.:,.::.: ,: :-:::~ ;i:":;:.:,,'.'- i Courtly and Stale In which administration proceedings are J COUNTY/PARISH pending or are completed. I 4. MARITAL HIS~OP~Y OF DECEDENT STATE NAME(S) & ADDRESS OF SPOUSE(S) MARRIAGE DATES MARRIAGE DATE OF DATE OF (IF NONE, PRiNT"NONE") '' ENDED BY DIVORCE DEATH FROM TO C AA A P© A I Ifil o OD,VORCE ?5 [] DIVORCE [] DEATH' [] DIVORCE INFORMATION FOR ALL CHILDREN OF THE DECEDENT (INCLUDING LEGALLY ADOPTED CHILDREN). CHILD'S NAME Date oi' Date ot MAILING ADDRESS (IF NONE, PRINT "NONE") Birth Death DECEDENT HAD NO CHILDREN, GIVE NAMES AND REQUESTED INFORMATION FOR PARENTS BROTHERS AND SISTERS ' NAME Ralallonshlp Dele of (IF NONE, PRINT 'NONE") to Decedent Dealh MAILING ADDRESS PAI~'ENT'S NAMES -OVER- -7. WERE THERE ANY CURRENT UNPAID lIENS, JUDGMENTS OR PENDING LITIGATIONS AGAINST THE DECEASED AT THE TIME OF HIS/HER DEATH? If so, please describe below: SATISFIED TO WHOM AMOUNT TYPE [] Yes [] Judgment [] Pending Litigation [] Lien Othe~ E] Judgment [] Pending Litigation ._1-1 Lien Other [] No [] Yes [] No State of '~ ) )ss County/Parish of ,_~/~'~ ~? ~- ' ,, ~\^~ 5, '~))~r~]~.) ~, of lawful age, being first duly sworn, upon my oath depose and say: That I am familiar with the family of the presently named decedent and was personally well acquainted with the decedent during his/her lifetime, having known him/her for ~)0 years, and that I bear tim relationship of ~ 0JL.J I fudher represent that the above statements and Information given are based upon my personal knowledge and are true and correct. NOTARY PUBLIC BROOKE CAMPBELL 455. East South Temple Salt Lake City, Utah 84111 My Commissibn Expires February 3, 2007 STATE OF UTAH MAILING ADDRESS CITY/STATE/ZIP CODE Subsc. ribed~and sworn to, bef~e me this ~(WITNESS) Expiration of Commission Post Office Box 4538 Houston, Texas 77210 Tel 713-752-3072 Fax 713-752-3040 ArtriciaLewis~chevrontexaco.com Artricia L. Lewis Land Ownership Assistant 311 March 12, 2003 ChevronTexaco, Dale Brown 382 G Street Salt Lake City, Utah 84103 Dear Mr. Brown: Listed below are the needed property descriptions. Please let me know if you have any questions. LABARGE TERTIARY EV 10270A To~vnship 27 North Range 311 West Section 27 GOVT-MINTON "A" Township 27 North Range 113 West Section 21 GOVT-MINTON "B" Township 27 North Range i 13 West Sections 27 and 28 LABARGE BR EVS010270A Township 27 North Range 1' 13 West Section 28 LABARGE CONS OT & ST FR EVS010270A Township 27 North Range 113 West Section 28 Sincerely, Artricia L. Lewis