HEIRSHIP AFFIDAVIT INFORMATION FORM

1. WHO IS MAKING THE AFFIDAVIT? (2 DISINTERESTED PARTIES REQUIRED)

NAME OF AFFIANT: __________________________________

AFFIANT=S ADDRESS: __________________________________

__________________________________
RELATIONSHIP TO DECEDENT: __________________________________
DATE AFFIANT MET DECEDENT: __________________________________

2. INFORMATION ON THE DECEDENT:

BIOGRAPHICAL:
DECEDENT=S FULL NAME: __________________________
DATE OF DEATH: __________________________
(ATTACH DEATH CERTIFICATE)
COUNTY OF DEATH: __________________________
HOW LONG LIVE IN COUNTY PRIOR TO __________________________
DEATH?
DID DECEDENT HAVE A WRITTEN WILL? YES _____ NO _____
(IF YES, ATTACH A COPY OF THE WILL)
WAS WILL FILED FOR RECORD? YES _____ NO _____
WAS WILL ADMITTED TO PROBATE? YES _____ NO _____
IF YES, WHERE? STATE _____ COUNTY ______

MARRIAGES:
FIRST MARRIAGE:
SPOUSE=S NAME: __________________________
DATE OF MARRIAGE: __________________________

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 PLACE OF MARRIAGE:
HOW DID MARRIAGE END?
NUMBER OF CHILDREN BORN:
NAMES OF CHILDREN BORN:
SECOND MARRIAGE:
SPOUSE=S NAME:
DATE OF MARRIAGE:
PLACE OF MARRIAGE
HOW DID MARRIAGE END?
NUMBER OF CHILDREN BORN:
NAMES OF CHILDREN BORN:
NUMBER OF ADDITIONAL MARRIAGES:
(USE BACK OF PAGE FOR ADDITIONAL MARRIAGES, IF NEEDED)
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__________________________
DEATH OF DECEDENT? 9
DEATH OF SPOUSE? 9
DIVORCE? 9
STATE ____________
COUNTY ____________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
DEATH OF DECEDENT? 9
DEATH OF SPOUSE? 9
DIVORCE? 9
STATE ____________
COUNTY ____________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
CHILDREN:
NAME: ____________________________ BIOLOGICAL 9
DATE OF BIRTH: ___________________ ADOPTED 9
OTHER PARENT: ___________________ STEPCHILD 9
ADDRESS: _________________________ FOSTER CHILD 9
_________________________
STILL LIVING? YES _______ NO ______
IF, DECEASED:
DATE OF DEATH: __________________________
PLACE OF DEATH: __________________________
MARRIED AT TIME OF DEATH? YES _____ NO _____
SPOUSE=S NAME:
CHILDREN BORN TO MARRIAGE? YES _____ NO _____
NAMES OF SURVIVING CHILDREN: __________________________
__________________________
__________________________
__________________________

NAME: ____________________________ BIOLOGICAL 9

DATE OF BIRTH: ___________________ ADOPTED 9
OTHER PARENT: ___________________ STEPCHILD 9
ADDRESS: _________________________ FOSTER CHILD 9
_________________________
STILL LIVING? YES _______ NO ______
IF, DECEASED:

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 DATE OF DEATH:
PLACE OF DEATH:
MARRIED AT TIME OF DEATH?
SPOUSE=S NAME:
CHILDREN BORN TO MARRIAGE?
NAMES OF SURVIVING CHILDREN:
__________________________
__________________________
YES _____ NO _____
__________________________
YES _____ NO _____
__________________________
__________________________
__________________________
__________________________

NAME: ____________________________ BIOLOGICAL 9

DATE OF BIRTH: ___________________ ADOPTED 9
OTHER PARENT: ___________________ STEPCHILD 9
ADDRESS: _________________________ FOSTER CHILD 9
_________________________
STILL LIVING? YES _______ NO ______
IF, DECEASED:
DATE OF DEATH: __________________________
PLACE OF DEATH: __________________________
MARRIED AT TIME OF DEATH? YES _____ NO _____
SPOUSE=S NAME: __________________________
CHILDREN BORN TO MARRIAGE? YES _____ NO _____
NAMES OF SURVIVING CHILDREN: __________________________
__________________________
__________________________
__________________________

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 __________________________
NAME: ____________________________ BIOLOGICAL 9
DATE OF BIRTH: ___________________ ADOPTED 9
OTHER PARENT: ___________________ STEPCHILD 9
ADDRESS: _________________________ FOSTER CHILD 9
_________________________
STILL LIVING? YES _______ NO ______
IF, DECEASED:
DATE OF DEATH: __________________________
PLACE OF DEATH: __________________________
MARRIED AT TIME OF DEATH? YES _____ NO _____
SPOUSE=S NAME: __________________________
CHILDREN BORN TO MARRIAGE? YES _____ NO _____
NAMES OF SURVIVING CHILDREN: __________________________
__________________________
__________________________

(USE BACK OF PAGE FOR ADDITIONAL CHILDREN, IF NEEDED)

EXTENDED FAMILY:

FATHER=S NAME: __________________________

BIOLOGICAL? 9 ADOPTIVE? 9
DATE OF BIRTH: __________________________
DATE OF DEATH: __________________________

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MOTHER=S NAME: __________________________
BIOLOGICAL? 9 ADOPTIVE? 9
DATE OF BIRTH: __________________________
DATE OF DEATH: __________________________

SIBLING NAME:
BROTHER 9 SISTER 9
DATE OF BIRTH: __________________________
DATE OF DEATH: __________________________

SIBLING NAME:
BROTHER 9 SISTER 9
DATE OF BIRTH: __________________________
DATE OF DEATH: __________________________

SIBLING NAME:
BROTHER 9 SISTER 9
DATE OF BIRTH: __________________________
DATE OF DEATH: __________________________

SIBLING NAME:
BROTHER 9 SISTER 9
DATE OF BIRTH: __________________________
DATE OF DEATH: __________________________

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( ADDITIONAL INFORMATION)

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