TJT-LETTER SIZE.doc; Revised 9/06/ljh
City
State
Zip
r See Attached (If more space is needed, check box, and attach.)
Date of Passing (Death)
Address of Decedent at Date of Passing (Death)
Use BLACK Ink Only
TERMINATION OF DECEDENT’S
PROPERTY INTEREST– HT110
OFFICE USE ONLY
Description of personal property (if any) being transferred. You may list savings accounts, checking accounts and securities on
attached pages. Indicate person(s) receiving property.
DECLARATION: I (We) declare that this document is, to the best of my (our) knowledge and belief, true, correct and complete and is
in conformity with the provisions and limitations of the Wisconsin Statutes. (If more space is needed, attach pages.)
STATE OF WISCONSIN, County of
Signed and sworn to before me on
by the above-named person(s).
Signature of Notary or other person authorized to administer an oath as per Sec. 706.06,
706.07
Print or type name:
Date Commission expires:
Decedent’s Name
PRESENTATION OF DEATH CERTIFICATE
I certify I have viewed a certified copy of the Decedent’s death certificate.
Register of Deed’s Signature
Date
Name and Return Address (below)
Parcel Identification Number (PIN/Tax Key No.)
This Document number is
, Volume
, Page
of record or deed.
This Document number is
, Volume
, Page
of record or deed.
These sections are to be completed in FRONT of Notary
NOTE: This document (when recorded) will serve as the NEW DEED to the property listed above.
Name and address of person(s) receiving property) Applicant’s Interest in Property Signature (notarized) Date
(List all remaindermen/beneficiaries; attach
(i.e. spouse, remainderman, beneficiary )
Addendum if necessary)
This document drafted by: