CLAIM # AFFIDAVIT OF HEIRSHIP residing ot ‘of lawful age upon oath and penalty of perjury State the following: am entitled to receive unclaimed property ftom the Office ofthe State Treasurer of Oklahoma, hich ba eutody af he property under the Oklahoma Unclaimed Property Act. Lam an heir of, ‘The listed owner was my. 1 (am) (am not) the only heir ofthe listed owner. (crele one) If am not the only her, [have provided the names, last known addresses, and where possible the phone numbers ofthe other heirs to the best of my knowledge inthe ATTACHMENT which is part of ths afidavit. If applicable, the ATTACHMENT must be returned. Initial the true statement: (1) There has been no known probate of the estate of ‘he Tisted owner and none is contemplated. ____ 2) There was a probate and a final order of distribution and the County Clerk of Court shows the case is closed. Send the ‘ertified final order of distribution (@) There was a probate but no final order of distribution and the County Clerk of Court shows the case as dismissed/closed; (4) There was a probate but no final order of distribution and the County Clerk of Court show the case as open, (6) The listed owmer had a trust atthe time of death and ibe property was included in the trust. Send a copy of the trust. agree to indemnify or repay the State of Oklahoma in whole or in part, if another claimant should assert and prove a superior claim tothe property. I also agree to indemnify the State of ‘Oklahoma for the property and attomey’s fees should a subsequent audit establish that there ‘was fraud in obtaining the property. ‘other heirs are to be paid and I receive the entie property, I agree to distribute the property to the other heirs entitled to the propery. (Gignature of Afiant & Print Nae) State of, Js ‘County of. ) Subscribed and sworn to before the undersigned notary this day of. 20, My Commission Expires: Notary Publi ‘Commission no (seal)ATTACHMENT TO THE AFFIDAVIT OF HEIRSHTP ‘The names, addresses and phone numbers of the other heirs ofthe listed owner are provided to the best of my knowledge. ‘Gignature of afftani/claimant; notarzation is unnecessary) Rem -eeerreeoreereo Naser EEPEeEPA CSE Baices Aaliess Phone number ‘Phone namber ‘Relsionsip to Lised Owner Felaionship to Dvted Owner me —___—_ Nese iis Kaeess Phone number Phone mamber Irthere are other heirs, please use an additional sheet. Verification of Instrument Please Check One: O] Trust 1 will I, the undersigned claimant, certify and swear that the foregoing instrument, as designated sbove, of. dated the __day of, [Trstor Owner's Name} 20___, isa true correct, and most current copy, including all amendments, [Monty ‘of said instrument, and tothe best of my knowledge has not been revoked by said ‘Trustor/Owner, BY CLAIMANT: ‘Signature (Please sign & print) FEE ee rere