Affidavit of Surviving Spouse or Next of Kin

 

VENUE.

               __________________________
                                   (State)

ss.

__________________________
(City)

 

I, _______________________________ ,being duly sworn according to law, declare that I
(Name)
reside at _______________________________________________________________
(Street address, city and state)
and that on ___________________________
(Month, day, year of death) ______________________________________________________________ had permanent legal (Name of deceased) residence at _____________________________________________________________________. (Complete address of the deceased) I am the _____________________________________________________________________ (Specify: widow, widower, eldest child, father, mother, other) and as such am entitled to receive the decedent''s estate under the laws of __________________________________________________________________________________ (Name of state in the U.S. where deceased last had permanent legal residence) To the best of my knowledge, __________________________________________________ (name of deceased)(did/did not) have a will.

NAME(S) OF SURVIVORS, IN ORDER OF KINSHIPPlease insert the name of living relatives in the following order of relationship: surviving spouse, children, father and/or mother, brothers and/or sisters: NameDate of BirthAddressTelephone No.Relationship 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. (Signature of Affiant) Subscribed and sworn to before me by (Type name of affiant) aton _____________________________ (Date) (Address of notary public) (Signature of Notary Public) (Typed name of Notary Public) American Citizens Services

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