Fill and Sign the Deed Research Department of Revenue Form

Heirship Affidavit Prepared by: If recorded, return to: ) ) ) ) ) ) ) ) ) ) -------------------above this line for official use only----------------- HEIRSHIP AFFIDAVIT (Heirship of _______________________________ Deceased) STATE OF GEORGIA 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
Was living and had the following: - -a. Current social security number. —b. Current medicare identification number, if available. —c. Current medicare supplement coverage under a part b HMO plan, if applicable. -d. Current medicaid identification number, if applicable. —e. Current medicaid supplement coverage under a part b medicaid plan, if applicable. —f. Current medicaid/medicare supplement coverage under any other federal or state government benefits program, if applicable. I received notice from (“family member") that decedent had: - -a. Died in a residence that he/she owned or resided in until the date of his/her death. —b. Received food stamps from the government (not cash) during the past 3 months. —c. Experienced an injury while living in a facility for indigent persons that lasted in excess of 1 month. —d. In the past three years received social security payments from the government for past-due (not paid) contributions to the social security disability or supplemental security income program but did not receive those payments after the date that decedent's social security number was lost/unknown. I swear or affirm that I am not a government official, or authorized to make any statements or take any actions concerning decedent's estate, or I am not making this statement in order to avoid or prevent liability arising by reason of any such statement. I further swear or affirm that I am not making this statement knowing that such statements are false. Furthermore, I hereby grant, release and discharge to (insert name of executor), (wife/husband/parent/other relative, or the designated agent, if any), and anyone else whom I may designate in writing a right of first refusal in my or their absence to receive an itemized list of claims against the estate of (deceased) (if no other claims have been made). This affidavit form may be signed and filed with the Georgia probate court or sealed and delivered to the appropriate representative and filed before a guardian ad item appointed in accordance with code §, , , , and <|endoftext|>after spending six years investigating the disappearance of a young girl from a remote corner of the arctic, a brave man who went missing himself is forced to take one last step — to uncover the truth he has been searching for in his own time.<|endowment|>i've