Affidavit of Heirship
State of
County of
I, , residing at , the decedent's , being of legal age, duly sworn, testify and state as follows:
(the "Decedent") passed away on , in , County, State of . I have known the Decedent since . The Decedent left no will, no issue, or collateral heirs other than those named herein. As the surviving heir to the estate of the Decedent, I request a release of the unclaimed funds.
Marital status of the Decedent. At the time of death, the Decedent was not married.
Property description. The Decedent is associated with the following estate (the "Estate"):
Heirs. To the best of my knowledge, the following persons are the Decedent's heirs:
Legal acknowledgment. I, , confirm and declare that the information provided in this Affidavit is true and accurate as far as I am aware, and I understand that any false statements may have legal consequences.
Signed on
__________________________
(Place for signature)
Witnesses. We, the undersigned, hereby certify and affirm that we are personally acquainted with the family and heirs of the Decedent, that we are not heirs and have no personal interest in the property, and that the information provided in this Affidavit regarding the heirs is true and accurate to the best of our knowledge. We declare that we are not financially interested in the proposed conveyance in connection with which this Affidavit is furnished and understand that it is secured to induce the transfer of the Estate the Decedent owns.
having their usual place of living at
_________________
(Place for signature)
Notary Acknowledgment
State of
Sworn to and subscribed before me on
Acting in the county of
_____________________________
(Notary public's name and seal)