Fill and Sign the Dc Deceased Form

Heirship Affidavit Prepared by: If recorded, return to: ) ) ) ) ) ) ) ) ) ) -------------------above this line for official use only----------------- HEIRSHIP AFFIDAVIT (Heirship of _______________________________ Deceased) STATE OF DISTRICT OF COLUMBIA 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), District of Columbia, _________________ (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 District of Columbia, 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, District of Columbia, _____________ 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: ___________________