AFFIDAVIT OF SURVIVING JOINT TENANT
STATE OF __________________ )
Now on this __________ day of __________, ______, I, _____________, of lawful age,
being duly sworn, state as follows:
On the _____ day of _______, ______, this interest was conveyed by document to
___________________________ as Joints Tenants, and not as Tenants in Common, with the
right of survivorship, the following real property situated in ____________ County, _________,
Section ______ Township _______, Range ________
Which document was recorded in the records of the County Clerk of ______ County, State
of__________, Book _____, at Page ______. There is attached hereto a certified copy of the
Death Certificate of ___________ deceased, issued by the Department of Health for the State of
__________ showing that the deceased Joint Tenant died on the ___ day of __________, _____.
Affiant further states that he/she is the surviving joint tenant in the described property,
and that the decedent named in the certificate of death is one and the same person as the joint
tenant named in the deed recorded as above set forth.
Affiant further states that on the date of deceased joint tenant’s death the two were
married to each other and that affiant is the surviving spouse.
And further affiant saith not.
Subscribed and sworn to before me this _______ day of __________________, _______.
STATE OF ____________________)
COUNTY OF __________________)
Before me, the undersigned, a Notary Public, in and for said County and State on the
______________________________ to me known to be the identical person who executed the
within and foregoing instrument and acknowledged to me that _____ executed the same as _____
free and voluntary act and deed for the uses and purposes therein set forth.
IN WITNESS WHEREOF, I have hereunto set my official signature and affixed my
official seal the day and year first above written.
My Commission Expires: