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AFFIDAVIT OF DEATH AND HEIRSHIP
DECEASED:
DATE:
SPECIFIC PROPERTY
DESCRIPTION:
SECTION/TOWNSHIP/RANGE:
COUNTY/STATE:
STATE OF
____________________
COUNTY OF
____________________
)
) Subscribed and Sworn Under Oath
)
I, __________ (first) _____(MI) __________________(last), the affiant (“I” or “my” hereinafter), being of lawful
age, being first duly sworn, upon oath deposes and states:
I was well acquainted with the above named deceased individual (“deceased” hereinafter) for _____ number of
years and the answers and statements given in the following questionnaire are based upon my personal
knowledge, true, and correct. Further, I am not a direct heir of the named deceased individual.
1.
What was your relationship to the deceased? ________________________________
2.
The deceased departed his/her life on __________ (month) ______ (day), _________(year) in
__________________ (county or city), _____________________ (state). He/She was ________ years old.
3.
The deceased owned t