AFFIDAVIT OF DEATH
FOR DISTRIBUTION OF DECEDENT'S PROPERTY
___________________________
PREPARED BY: )
________________________. )
________________________
________________________ )
________________________, )
________________________
________________________
AFTER RECORDING RETURN TO: )
________________________. )
________________________
________________________ )
________________________, ) ABOVE SPACE FOR RECORDER'S USE
________________________
________________________
STATE OF ________________________ )
) ss.
COUNTY OF ________________________ )
I, ________________________. ________________________, being of the legal age of consent,
being duly sworn, depose and state that I wish to claim property of the deceased,
________________________. ________________________, whose social security number is
_______________________ and who was a resident of the state of ________________________
at the time of death on ________________________.
The value of the decedent's entire estate subject to probate, wherever located, less liens and
encumbrances, does not exceed the amount of ________________________, and at least
________________________ days have elapsed since the decedent's death. No application or
petition for the appointment of a personal representative is pending or has been granted in any
jurisdiction.
All debts of the decedent, including funeral and burial expenses and all unsecured debts, have been
paid or provided for.
THEREFORE, I am claiming the following portions of the decedent's following property:
________________________
All of the property noted above shall be subject to probate.
I have personally served or mailed written notice to all other successors of the decedent identifying
my claim and describing the property claimed. At least ten (10) days have passed since the service
and/or mailing of such notice. Thus, I am entitled to full payment and/or delivery of the property
claimed on my behalf, and on the behalf of any other successor from whom I have attached to this
affidavit a written authorization.
DULY SWORN AND AUTHORIZED, I certify under penalty of perjury under
________________________ law that the contents of the aforementioned Affidavit are true and
correct to the best of my knowledge.
________________________
(PETITIONER SIGNATURE) (DATED)
________________________.
________________________
STATE OF ________________________ )
) ss.
COUNTY OF ________________________ )
The foregoing instrument was acknowledged before me on ____________________ by
________________________. ________________________, the "Petitioner," personally
appearing before me to execute the foregoing instrument.
Witness my hand and official seal.
___________________________________________
(Notary Public Signature)
___________________________________________
(Notary Printed Name)
My Commission Expires: ______________________
DOCUMENT TIPS
Please note that in order to file this document, you must also complete the following:
__________________________
ü Please remember to add the Social Security number of the decedent to this affidavit. For
security purposes, please write it on your completed document.
ü Please remember that this affidavit must be notarized.
ü Prior to the filing of this affidavit, notices must be sent to heirs, successors or assigns of
the Decedent notifying them of your intents.
ü Please verify that no other Personal Representative claim has been filed or decreed for the
Decedent's estate.
ü Please confirm that the value of the estate you are claiming does not exceed the maximum
total value of estate allowable on this affidavit pursuant to state law.
ü Please ensure that this affidavit is not filed prior to the mandatory waiting period after the
Decedent's death determined by your state.
