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Heirship Affidavit
Prepared by:
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-------------------above this line for official use only-----------------
HEIRSHIP AFFIDAVIT
(Heirship of _______________________________ Deceased)
STATE OF KENTUCKY
COUNTY OF _____________ )
)
BEFORE ME, the undersigned authority, on this day personally appeared _____________________________,
("AFFIANT") who is personally known to me (or, if not being personally known to me, did confirm his/her identity
presenting ______________________ as identification (i.e. drivers license #), and appearing to be fully competent and
of sufficient age, upon being duly sworn, stated upon Affiant's oath the following:
1. My name is ________________________________________ (insert name of affiant), and I live at
________________________________________________________ (insert address of affiant's residence). I
am personally familiar with the family and marital history of ____________________________________
("Decedent") (insert name of decedent), and I have personal knowledge of the facts stated in this affidavit.
2. I knew decedent from _______________________ (insert date) until _________________________ (insert
date). I was personally well acquainted with the named decedent during his/her lifetime.
3. The Decedent died on _________________________________________ (insert date of death) at the
following place of death: _____________________________________(City), ______________________,
(County), _________________________ (State) (insert place of death). At the time of decedent's death,
decedent's residence address was
____________________________________________________________________ (Street),
_________________________________(City), Kentucky , _________________ (Zip).(insert address of
decedent's residence).
4. I was well acquainted with the family and near relatives of the said decedent, and with all those who
would under the laws of the State of Kentucky , be his/her heirs. The following statements and the information
contained herein, including my answers to named questions below, are based upon my personal
knowledge and are true and correct.
QUESTION 1 - Did the decedent leave a will? ANSWER : YES/NO
QUESTION 2 - If the decedent left a will, has the will been admitted to probate?
ANSWER : YES/NO/NA. If YES, at what place, and when?
ANSWER : _________________COUNTY, Kentucky , _____________ CAUSE NUMBER
______________ DATE
QUESTION 3 - If the decedent left no will, has an administrator or personal representative been appointed for the
estate of said deceased? ANSWER : YES/NO
Heirship Affidavit
QUESTION 4 - If an administrator or personal administrator has been appointed, give the County in which the
proceedings are pending, and the name and address of the administrator or personal representative.
ANSWER :
COUNTY
CAUSE NUMBER NAME ADDRESS
QUESTION 5 - Give the name and address of the surviving widow or widower of decedent.
ANSWER :
NAME ADDRESS If not now living, state date of
death:
QUESTION 6 - If the decedent was married more than once, give the name(s) of the former husband or wife, and
state whether said former spouse is dead or divorced.
ANSWER :
NAME STATUS (Dead or Divorced)
QUESTION 7 - Give the names and places of residence of all the surviving children of deceased, together with
the other information called for:
ANSWER : (Give names of surviving children only)
NAME OF CHILD ADDRESS DATE OF
BIRTH IF NOT
LIVING
DATE OF
DEATH HUSBAND OR WIFE
NAME
QUESTION 8 - Give the name and address of any deceased children of the decedent, together with the other
information called for:
ANSWER :
Heirship Affidavit
NAME OF CHILD DATE OF
BIRTH DATE OF
DEATH SURVIVING
HUSBAND OR WIFE
NAME DATE OF
DEATH OF
SPOUSE, IF
APPLICABLE
QUESTION 9 - Give the names and addresses of the children of any deceased son or daughter of the decedent:
ANSWER :
NAME OF CHILD ADDRESS OF IF NOT
LIVING DATE OF
DEATH DATE OF
BIRTH NAME OF FATHER OR
MOTHER
QUESTION 10 - Did the decedent have any adopted children, or step-children taken into his home?
ANSWER : YES/NO. If yes, provide their names, ages and addresses below:
NAME ADDRESS AGE
QUESTION 11 - Did the decedent have any unpaid debts? ANSWER : YES/NO.
If yes, provide as nearly as possible the amount of the debt and creditor and whether such debt has since been paid
ANSWER :
CREDITOR AMOUNT OF DEBT HAS DEBT NOW BEEN PAID
Heirship Affidavit
QUESTION 12 - If the decedent left no children, then give below the names and addresses (together with other
information called for), or his or her surviving father, mother, brothers, sisters:
ANSWER:
NAME RELATIONSHIP AGE ADDRESS OR DATE OF
DEATH
QUESTION 13 - If the decedent left no children, spouse, mother, father, brother or sister, state all other known
relatives:
ANSWER:
NAME RELATIONSHIP AGE ADDRESS
Heirship Affidavit
QUESTION 14: Did the decedent own any real estate in this State:
ANSWER: YES/NO
If yes, list
Address or short description : ____________________________________________________________________
County: ________________________
Address or short description : ____________________________________________________________________
County: ________________________
Address or short description : ____________________________________________________________________
County: ________________________
Address or short description : ____________________________________________________________________
County: ________________________
Address or short description : ____________________________________________________________________
County: ________________________
QUESTION 15 : What is your relationship to the deceased?
ANSWER :
DATED THIS THE ________ DAY OF _______________________, 20____.
___________________________________
Signature of Affiant
SWORN TO AND SUBSCRIBED before me this the _______ day of ______________, 20___.
__________________________
NOTARY PUBLIC
My Commission Expires: ___________________
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FAQs
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