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Get and Sign Affidavit of Descendants 2012-2022 Form
Beneficiary. Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more
room for information, use a copy of the relevant page.
1. Beneficiary Information
First Name
Social Security Number
M.I.
Last Name
M.I.
Last Name
Date of Death MM DD YYYY
The beneficiary is:
Deceased.
Check one.
Disclaiming the assets.
2. Affidavit of Descendant(s)
State
County
The undersigned,
First Name
being duly sworn, deposes and states that you reside...
Show details
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