Fill and Sign the Affidavit Death Form

AFFIDAVIT OF DEATH OF JOINT TENANT STATE OF ______________________} SS COUNTY OF ____________________} BEFORE ME, the undersigned Notary Public, personally appeared, _______________________________, “Affiant”, who upon being duly sworn, deposes and states upon his or her oath or affirmation, the following: 1. My name is ____________________________ and I reside at _____________________. 2. I owned real property as a joint tenant with ______________________________, such real property located in ________________ County, State of ______________________, described as follows: See Attached Legal Description. Title deed is recorded in Book ___________, Page __________ in the office of the register of deeds in the county and state aforesaid. 3. ______________________________, my joint tenant identified above, departed this life on the ____ day of __________________, 20____ . A copy of the death certificate of _________________________ is attached. 4. On the date of the death of ________________________________, the above described real estate was owned by ______________________________ and _________________________________, as joint tenants and the joint tenancy had not been severed by any act of the parties or by operation of law. 5. Affiant is the sole surviving joint tenant of the property described above. Dated this the _________ day of ____________________, 20________. _________________________ Affiant - 1 - SWORN TO AND SUBSCRIBED before me this the _______ day of ______________, 20_______. __________________________ NOTARY PUBLIC My Commission Expires: ___________________ - 2 -