Affidavit of Surviving Spouse or Next of Kin
VENUE. __________________________ (State) ss. __________________________
(City) I, _______________________________ ,being duly sworn according to law,
declare that I (Name) reside at
_______________________________________________________________ (Street address,
city and state) and that on ___________________________ (Month, day, year of
death) ______________________________________________________________ had
permanent legal (Name of deceased) residence at
_____________________________________________________________________. (Complete
address of the deceased) I am the
_____________________________________________________________________ (Specify:
widow, widower, eldest child, father, mother, other) and as such am entitled to
receive the decedent's estate under the laws of
__________________________________________________________________________________
(Name of state in the U.S. where deceased last had permanent legal residence) To
the best of my knowledge, __________________________________________________
(name of deceased) (did/did not) have a will. NAME(S)
OF SURVIVORS, IN ORDER OF KINSHIP Please insert the name of
living relatives in the following order of relationship: surviving spouse,
children, father and/or mother, brothers and/or sisters: Name Date of Birth
Address Telephone No. Relationship 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. (Signature
of Affiant) Subscribed and sworn to before me by (Type name of affiant) at on
_____________________________ (Date) (Address of notary public) (Signature of
Notary Public) (SEAL) (Typed name of Notary Public)
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