Form Rev 80 0029 - Affidavit Of Successor Page 2

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Deceased Name:
What is the relationship to the deceased:
Spouse (date of marriage
)
Parent
Niece/Nephew
Child
Granddaughter/son
Other
Did the deceased leave a will?
Yes - skip to question 1
No - answer questions 2 through 5
1.
If the decedent left a will, was it probated?
Yes - Do not use this form, send the following items:
1.
Copy of the will
2.
Addresses for all heirs
No - Complete this form and send a copy of the will.
2.
Was the deceased married when they passed away?
Yes, spouse’s name
Are they living?
Yes
No - If no, provide date of death
No
3.
How many children did the deceased have? List the names of the children (if deceased, include date of death)
4.
Are the parents of the deceased living?
Yes - If yes, provide their names
No
5.
How many brothers and sisters did the deceased have? List their full names (if deceased, include date of death)
Print This Form
If you are claiming as a remote relative, you must provide a complete family tree showing your relationship to the deceased.
The family tree should include names and dates of death for all relatives of the deceased.
For tax assistance visit ucp.dor.wa.gov or call 1-800-435-2429. To inquire about the availability of this document in an alternate format for the visually
impaired, please call (360) 705-6715. Teletype (TTY) users may call 1-800-451-7985.
REV 80 0029 (3/31/09)
Reset This Form

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