TO BE FILLED OUT BY A DISINTERESTED THIRD PARTY!
AFFIDAVIT OF DEATH AND HEIRSHIP
STATE OF __________________δ
δ
COUNTY OF ________________δ
Before me, the undersigned authority, on this day personally appeared ____________________________________,
affiant, and on ________ oath says that
is over 21 years of age and is not incapacitated in any way, and that the
statements hereinafter set forth, including answers to questions propounded, constitute a true, correct and complete
statement of the family history of the persons hereinafter named as “decedent” and of the estate of such decedent.
1. Name of decedent ____________________________________________________________________________
2. Date decedent died ________________________ Where?____________________________________________
3. Did decedent leave a will? _________ If so, has it been probated?______________________________________
4. Has any administration proceeding been had on decedent’s estate?______________________________________
5. If so, when?_____________________ Where?______________________________________________________
6. Were there any unpaid debts or obligations due by decedent at the time of his/her death?____________________
7. If so, give the following information:
To Whom Owning
Amount
Nature of Debt
Paid or Unpaid Now
8. Were there any suits pending or any judgments rendered in any Court against decedent at time of death?________
9. If so, state briefly the nature, amount involved, and parties to the action.
10. Was decedent married or single at the time of death?________________________________________________
11. If married, to whom?_________________________________________ Date of marriage__________________
12. Was decedent ever married to any other than the above mentioned person?______________________________
13. If so, give the following information: (List names in order of marriage)
Date of
Living
Date of Death
Name of Spouse
Marriage
or Dead
Divorced
or Divorce
14. If decedent had any children by any spouse named above, give the following information:
Date of
Living
Date of
By Which
Name of Child
Birth
Address
or Dead
Death
Spouse
_____________________________________________________________________________________________
15. Did decedent ever adopt any children?___________________________________________________________
16. If so, give date of adoption and also the same information as called for above:____________________________