Transfer On Death Instrument Page 3

Beneficiary Print name

sTaTe Of iLLinOis

)

cOUnTy Of

)

i, the undersigned, a notary Public in and for the said county, in the state aforesaid, dO HereBy cerTify THaT

[name Of Beneficiary(ies)], personally known to me to be the same person(s)

whose name(s) is/are subscribed to the foregoing instrument, appeared before me this day in person and swore on oath to the above fore-

going affidavit.

signed and sworn to before me this

day of

, 20

notary Public

nOTice: This notice of death affidavit and acceptance form or equivalent form must be recorded by the beneficiary within 30 days of

the death of the owner to make the transfer on death instrument effective. you should consult a lawyer before using this form.

0 votes

Parent category: Business