Affidavit Of Death And Heirship Form Page 2
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2AFFIDAVIT OF DEATH AND HEIRSHIP
Page 2 of 2
17. Was decedent the parent of any illegitimate children?_______________________________________________
18. If so, give the information as called for above:_____________________________________________________
19.*If a deceased child left descendants, give the following information:
Living
Date of
Name of Child
Date of Birth
Address
or Dead
Death
Name of Deceased Child
________________________________________________________________________
Name of Deceased Child
________________________________________________________________________
Date of
20.*Name of Parents
Address
Living or Dead
Death
Mother
Father
21.*Names of brothers and sisters of decedent:
Name
Relationship
Address
Living or Dead
Date of Death
Briefly state facts and circumstances (such as being an old friend, relative, attorney or agent for decedent) which
will show basis and source of the information which has been hereinabove give.
STATE OF ______________________________ δ
δ
COUNT (PARISH) OF _____________________ δ
______________________________________, of lawful age, being first duly sworn, on oath states: that this
(Name of Affiant)
affiant was well and personally acquainted with ___________________________________ in ______ lifetime; that
(Decedent)
this affiant has read the foregoing Proof of Death and Heirship, knows the contents hereof, and that each and every
statement contained therein is true.
___________________________________________
(Affiant)
SUBSCRIBED AND SWORN TO BEFORE ME by the said ____________________________________________
THIS ______ day of ________________________, 20____.
My commission expires:
___________________________________________
Notary Public in and for
*If additional space is required, use reverse side of this sheet.
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