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Form preview Oregon heirship form Heirship Affidavit Prepared by -------------------above this line for official use only----------------- If recorded return to HEIRSHIP AFFIDAVIT Heirship of Deceased STATE OF OREGON 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 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. I knew decedent from insert date until insert date. I was personally well acquainted with the named decedent during his/her lifetime. 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 would I was well acquainted with the family and near relatives of the said decedent and with all those who under the laws of the State of Oregon 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 Oregon CAUSE NUMBER estate of said deceased ANSWER YES/NO 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 NAME ADDRESS CAUSE NUMBER QUESTION 5 - Give the name and address of the surviving widow or widower of decedent. If not now living state date of death state whether said former spouse is dead or divorced* STATUS Dead or Divorced other information called for ANSWER Give names of surviving children only NAME OF CHILD DATE OF BIRTH IF NOT LIVING DEATH HUSBAND OR WIFE information called for SURVIVING SPOUSE IF APPLICABLE ADDRESS OF IF NOT LIVING DATE OF NAME OF FATHER OR MOTHER ANSWER YES/NO. If yes provide their names ages and addresses below AGE 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 NOW BEEN PAID RELATIONSHIP ADDRESS OR DATE OF relatives If yes list Address or short description QUESTION 15 What is your relationship to the deceased DATED THIS THE DAY OF 20. Signature of Affiant SWORN TO AND SUBSCRIBED before me this the day of 2000. NOTARY PUBLIC My Commission Expires. 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. I knew decedent from insert date until insert date. I was personally well acquainted with the named decedent during his/her lifetime.
Form preview Ohio affidavit descent form Prepared by -------------------above this line for official use only----------------- If recorded return to HEIRSHIP AFFIDAVIT Heirship of Deceased STATE OF OHIO 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 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. I knew decedent from insert date until insert date. I was personally well acquainted with the named decedent during his/her lifetime. 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 residence. would I was well acquainted with the family and near relatives of the said decedent and with all those who under the laws of the State of Ohio 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 Ohio CAUSE NUMBER estate of said deceased ANSWER YES/NO 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 NAME ADDRESS CAUSE NUMBER QUESTION 5 - Give the name and address of the surviving widow or widower of decedent. If not now living state date of death state whether said former spouse is dead or divorced* STATUS Dead or Divorced other information called for ANSWER Give names of surviving children only NAME OF CHILD DATE OF BIRTH IF NOT LIVING DEATH HUSBAND OR WIFE information called for SURVIVING SPOUSE IF APPLICABLE ADDRESS OF IF NOT LIVING DATE OF NAME OF FATHER OR MOTHER ANSWER YES/NO. If yes provide their names ages and addresses below AGE 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 NOW BEEN PAID RELATIONSHIP ADDRESS OR DATE OF relatives If yes list Address or short description QUESTION 15 What is your relationship to the deceased DATED THIS THE DAY OF 20. Signature of Affiant SWORN TO AND SUBSCRIBED before me this the day of 2000. NOTARY PUBLIC My Commission Expires. 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. I knew decedent from insert date until insert date. I was personally well acquainted with the named decedent during his/her lifetime.
Form preview Cohabitation agreement form Cohabitation Agreement Between Parties Living Together but Remaining Unmarried with Residence Owned by One of the Parties Agreement made on the day of 20 between Male Party of and Female Party of county state zip code. If the parties are living at any other residence solely owned by notice of termination of the Agreement by the other party. other or their cohabitation with or marriage to any other party. without the consent of the other party. Other or their cohabitation with or marriage to any other party. without the consent of the other party. Prior to the termination of this Agreement all matters dealing with the property earnings and debts of the parties shall be governed by this Agreement. Waiver of Right to Support or Other Compensation Each party waives the right to receive financial support or other assistance from the other party during the parties cohabitation prior to or after execution of this Agreement or on termination of the cohabitation of the parties or at any subsequent time. Whereas the parties to this Agreement have been living together since date at street address city Whereas each of the parties is an unmarried adult and a resident of state and Whereas Male Party is presently employed as He has an interest in a profit-sharing plan and a pension fund all as more fully set forth in Schedule A which is attached and incorporated in this Agreement by reference. Whereas each party has had the opportunity to review this Agreement with counsel of his or her own choice. Name of attorney has represented Male Party and execution of this Agreement. with one another while living together and law of state defining the rights and duties of persons living together in an unmarried state and by virtue of the parties cohabiting with one another Now therefore for and in consideration of the mutual covenants contained in this agreement and other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged the parties agree as follows I. Confirmation of Separate Property Earnings and Debts A. listed on Schedule A which is attached to and incorporated in this Agreement by reference. B. property listed on Schedule B which is attached to and incorporated in this Agreement by reference. C. The parties agree that all of the items listed on Schedules A and B together with any items inadvertently omitted are and shall remain the separate property of the person who presently owns the property. Neither party acquires nor shall acquire any right title or interest in any of the property listed by the other party as his or her separate property. Neither party may acquire any interest in the property of the other that is set forth on Schedules unless the party does so by an instrument in writing signed by both parties subsequent to the date of this Agreement. Each party specifically waives any right title or interest that he or she may have in such property. Each party agrees to assume and pay and hold the other party harmless from all debts liabilities or claims arising out of or in connection with his or her separate property as described in this Agreement.
Form preview Nicor gas fraud affidavit form A group of credit grantors consumer advocates and attorneys at the Federal Trade Commission FTC developed an ID Theft Affidavit to make it easier for fraud victims to report information. Nicor Gas Company utilizes this form and in addition requires a copy of a police report proof of residency during disputed time frame and a copy of a photo I. It will be necessary to provide the information in this affidavit anywhere a new account was opened in your name. The information will enable Nicor Gas Company to investigate the fraud and decide the outcome of your claim. If someone made unauthorized changes to an existing account please call the company at 1 888 Nicor-4-U 1 888 -642-6748 to discuss with one of our call center representatives. The information will enable Nicor Gas Company to investigate the fraud and decide the outcome of your claim. If someone made unauthorized changes to an existing account please call the company at 1 888 Nicor-4-U 1 888 -642-6748 to discuss with one of our call center representatives. Part One the ID Theft Affidavit is where you report general information about yourself and the theft. Instructions for Completing the ID Theft Affidavit To make certain that you do not become responsible for any debts incurred by an identity thief you must prove to each of the companies where accounts were opened or used in your name that you didn t create the debt. D. to be attached to your submission* A completed ID Theft Affidavit must be submitted in order to prove that you did not open or post unauthorized charges to a Nicor Gas account. Other companies could require that you submit more or different forms. Before you send the affidavit contact each company to find out if they accept it. It will be necessary to provide the information in this affidavit anywhere a new account was opened in your name. The information will enable Nicor Gas Company to investigate the fraud and decide the outcome of your claim* If someone made unauthorized changes to an existing account please call the company at 1 888 Nicor-4-U 1 888 -642-6748 to discuss with one of our call center representatives. Part One the ID Theft Affidavit is where you report general information about yourself and the theft. Part Two the Fraudulent Account Statement is where you describe the fraudulent account s opened in your name. Use a separate Fraudulent Account Statement for each account if there are multiple accounts or address included in your claim* The above information can be submitted via facsimile to 630 9834229 or via US Mail to PO Box 2020 Aurora IL 60507. When you send the affidavit via US Mail attach copies NOT originals of any supporting documents for example driver s license or police report. Before submitting your affidavit review the disputed account s with family members or friends who may have information about the account s or access to them* Be as accurate and complete as possible. Incorrect or incomplete information will slow the process of investigating your claim and absolving the debt.
Form preview Ak affidavit form You must sign this statement. It is advisable but not required that a witness sign also. The witness s address should also be included. RECORD THIS AFFIDAVIT AT THE RECORDING DISTRICT WHERE THE CLAIM LEASEHOLD LOCATION OR MINING LEASE IS LOCATED WITHIN 90 DAYS AFTER THE END OF THE ASSESSMENT YEAR.. You may use one affidavit of annual labor for a group of claims. Instructions 1. Fill in the year for which you are claiming annual labor. 2. List the name and mailing address of the current owner where correspondence should be sent. Under Alaska regulations it is your responsibility to be sure that the Division of Mining Land Water has your current address. 2. List the name and mailing address of the current owner where correspondence should be sent. Under Alaska regulations it is your responsibility to be sure that the Division of Mining Land Water has your current address. You must notify the division of any address changes in writing. Addresses will not be updated based on a different address indicated on this affidavit. Number of days X number of workers total number of person-days worked. 8. Describe the work performed in as much detail as necessary to support the value you declare in the affidavit for example sunk shaft 10 feet stripped 150 cubic yards of overburden with D-6 cat in preparation for mining core drilling 150 feet sluiced 5000 cubic yards of gravel. This affidavit must still be timely recorded. Name s and address es of person s who did the work Name I swear under penalty of perjury that the foregoing is true. Print Name x Signature of Affiant Notary Block Subscribed and sworn before me this day of Signature of notary My commission expires. Please Do Not Record This Page GENERAL INFORMATION A. claims leasehold locations or mining leases. The minimum amount of labor required to be expended for each mining claim or leasehold location is 100. Acrobat Reader will not save your input data. Sign and Mail the completed form to the Recorder s Office in the District where the claims are located. DOM 20-83 revised 10/04 DNR 10-84 AFFIDAVIT OF ANNUAL LABOR FOR MINING This affidavit of annual labor is for the assessment year which ended at noon on September 1 20 Correspondence should be sent to Recording District Owner s Name Meridian Mailing Address Twn Rng Sec s City State Zip Names of Mineral Locations ADL Numbers Attach additional sheets if necessary Work was performed on the following dates Number of person days worked Description of work performed Declared value of work performed during this labor year not including claim maintenance Value of excess work credit to be applied from previous labor year s if applicable Amount of any cash payment made to the state instead of performing labor if applicable NOTE Cash payments made to the state in-lieu-of performing labor must be received prior to September 1. Electronic Form Instructions Mouse Click or Tab to the line and type in your infomation* Print the completed form before you close the file.

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