Fill and Sign the Heirship 481378141 Form

1 Prepared By and After Recording Return to: Send Tax Statements to (Name and Address): --------Above This Line Reserved For Official Use Only-------- HEIRSHIP AFFIDAVIT (Heirship of ______________________________ Deceased) STATE OF OKLAHOMA 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 ____________________________________, and I live at ____________________________________________________________ (insert address of affiant's residence). I am personally familiar with the family and marital history 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), Oklahoma, ____________ (Zip). 4. I was well acquainted with the family and near relatives of the said dec edent, and with all those who would under the laws of the State of Oklahoma , 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. 2 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? __________________ COUNTY, Oklahoma , __________________ 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 QUESTION 4 - If an administrator or personal administrator has been appointed, give the County in whi ch the proceedings are pending, and the name and address of the administrator or personal representative. ANSWER: County Cause No. Name Address Telephone: QUESTION 5 - Give the name and address of the surviving widow or widower of decedent. ANSWER: Name: Street Address: City: State, Zip Code: If not living, 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 : FULL NAME STATUS (dead or Divorced) 3 QUESTION 7 - Give the names and places of residence of all the surviving children of deceased, t ogether with the other information called for: ANSWER : (Give names of surviving children only) Name: Street Address: City: State, Zip Code: Date of Birth: If not living, date of death: Husband or Wife’s Name: Name: Street Address: City: State, Zip Code: Date of Birth: If not living, date of death: Husband or Wife’s Name: Name: Street Address: City: State, Zip Code: Date of Birth: If not living, date of death: Husband or Wife’s Name: Name: Street Address: City: State, Zip Code: Date of Birth: If not living, date of death: Husband or Wife’s Name: QUESTION 8 - Give the name and address of any deceased children of the decedent, together with the other information called for: ANSWER: 4 Name of Child: Date of Birth: Date of Death: Surviving Husband or Wife’s Name: Date of Death of Spouse, if applicable: Name of Child: Date of Birth: Date of Death: Surviving Husband or Wife’s Name: Date of Death of Spouse, if applicable: Name of Child: Date of Birth: Date of Death: Surviving Husband or Wife’s Name: Date of Death of Spouse, if applicable: Name of Child: Date of Birth: Date of Death: Surviving Husband or Wife’s 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, if not living, date of death: Date of Birth: Name of Father or Mother: Name of Child: Address, if not living, date of death: Date of Birth: Name of Father or Mother: Name of Child: Address, if not living, date of death: Date of Birth: Name of Father or Mother: 5 Name of Child: Address, if not living, date of death: Date of Birth: Name of Father or Mother: Name of Child: Address, 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: Street Address: City: State, Zip Code: Age: Name: Street Address: City: State, Zip Code: Age: Name: Address: Street Address: City: State, Zip Code: 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. CREDITOR AMOUNT OF DEBT HAS DEBT BEEN PAID? (Yes or No) 6 QUESTION 12 - If the decedent left no children, then give below the names and addresses (togethe r with other information called for), or his or her surviving father, mother, brothers, sisters: ANSWER: Name: Relationship: Age: Street Address: City, State, Zip Code: If deceased, date of death: Name: Relationship: Age: Street Address: City, State, Zip Code: If deceased, date of death: Name: Relationship: Age: Street Address: City, State, Zip Code: If deceased, date of death: QUESTION 13 - If the decedent left no children, spouse, mother, father, brother or sister, state all ot her known relatives: ANSWER: Name: Relationship: Age: Street Address: City, State, Zip Code: If deceased, date of death: Name: Relationship: Age: 7 Street Address: City, State, Zip Code: If deceased, date of death: Name: Relationship: Age: Street Address: City, State, Zip Code: If deceased, date of death: Name: Relationship: Age: Street Address: City, State, Zip Code: If deceased, date of death: 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: QUESTION 15 : What is your relationship to the deceased? ANSWER: DATED: ________________________ 8 ____________________________________Signature of Affiant STATE OF OKLAHOMA COUNTY OF __________________ This instrument was acknowledged before me on ________________________ (date) by ______________________________ (name(s) of person(s)). ____________________________________ NOTARY PUBLIC Print Name My Commission Expires: ________________________