This Affidavit must be completed by a third disinterested party (Affiant) who will not benefit from the decedent’s estate. Do not
complete this form if the decedent left a will that was probated in court or there has been some other type of court determina-
tion to the estate.
Affidavit of facts concerning the identity of Heirs for the Estate of: _____________________________________________
Before me, the undersigned authority, on this day personally appeared: ________________________________________
(“Affiant”) who, being first duly sworn, upon his/her oath states:
1. My name is: ___________________________________________________________________________________ .
I live at: _______________________________________________________________________________________
I am personally familiar with the family and marital history of: ______________________________________________
(Decedent), and I have personal knowledge of the facts stated in this Affidavit.
2. I knew the decedent from ________________until ________________ Decedent died on ______________________ .
Decedent’s place of death: ________________________________________________________________________
At the time of decedent’s death,
decedent’s residence was: ________________________________________________________________________
NAME OF SPOUSE
3. Provide the following information on the deceased’s marital history:
(If never married, please state that below.)
NAME OF CHILD/
NAME OF CHILD’S
4. Provide the following information on the deceased’s natural born and adopted children:
(If there are none, please state that below. If additional space is needed, please provide information as an attachment.)
NAME OF CHILD/
NAME OF GRANDCHILD’S
5. Provide the following information on the deceased’s grandchildren, born only to the deceased children in Item 4, above: