Fill and Sign the Transferring Death Form

AFFIDAVIT AS TO TERMINATION OF JOINT TENANCY WITH RIGHT OF SURVIVORSHIP BY SURVIVING TENANT (One Tenant is Deceased) State: ___________________ County: ___________________ Affiant: ___________________ (Name and Address) Affiant, on oath, swears that the following statements are true: 1. My name is ___________________ . I was a grantee in a (deed/assignment) , dated ___________________ , recorded in Volume _______ , page _______ , of the ___________________ records of ___________________ County, ___________________ ,in which ___________________ and myself were conveyed title to interests in lands described in the (deed/assignment) as Joint Tenants with Rights of Survivorship. 2. ___________________ , my fellow joint tenant, is now deceased. A copy of the original Death Certificate of _____ is attached to this Affidavit as evidence of that fact. 3. Affiant is the surviving joint tenant. 4. I now deem myself to be the sole owner of the property described in the (deed/assignment) referenced above. _______________________________ Affiant (The following acknowledgement is not geared toward the law of any particular state an d is subject to modification) ACKNOWLEDGMENT State of _____________________________ County of _____________________________ On _____________________________ , _____________________________ personally appeared before me and proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of _____________________________ that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature of Notary (Seal) My Commission Expires _____________________ (Attachment)