Fillable Printable Affidavit of Heirship - Nevada
Fillable Printable Affidavit of Heirship - Nevada
Affidavit of Heirship - Nevada
CLAIM #_____________
1 of 2 Revised: 02/22/10—UP 40
AFFIDAVIT OF HEIRSHIP
DO NOT COMPLETE THIS FORM IF THE DECEDENT LEFT A WILL THAT WAS PROBATED IN COURT OR IF THERE HAS
BEEN SOME OTHER TYPE OF COURT DETERMI NATION TO THE ESTATE
.
You may use an attachment if additional space is required.
Affidavit of facts concerning the identity of Heirs for the estate of: ___________________________________________
(“Decedent”)
BEFORE me, the undersigned authority, on this day personally appeared: _______________________ who, being first duly
(“Affiant”)
sworn upon his/her oath states:
1.
M
Y NAME IS:
I RESIDE A T:
DECEDENT WAS
MY
(RELATION):
I am personally familiar with the family and marital history of ________________________, and I have personal knowledge
(“Decedent”)
of the facts stated in this aff i davit.
2.
I
KNEW THE DECEDENT FROM: UNTIL:
DECEDENT DIED ON MONTH: DATE:
Y
EAR:
DECEDENT’S PLACE OF DE ATH CITY: STATE:
C
OUNTY:
DECEDENT’S RESIDENCE AT TIME
OF DEATH
: CITY: STATE COUNTY
3. Provide information on the decedent’s marital history: (If never married, indicate below.)
N
AME OF SPOUSE DATE OF MARRIAGE DATE OF DIVORCE DATE OF SPOUSE’S DEATH
4. Provide the following information on the decedent’s natural born and adopted children: (If none, indicate below.)
C
HILD’S NAME & CURRENT ADDRESS
B
IRTH
DATE
N
AME OF CHIL D’S
OTHER PARENT
D
ATE OF
CHILD’S DEAT H
__________________________
__________________________
__________________________
__________________________
__________________________
2 of 2 Revised: 02/22/10—UP 40
5. Provide the following information on the decedent’s grandchildren, born only to the deceased children in item 4 above.
(If none, indicate below.)
G
RANDCHILD’S NAME/
CURRENT ADDRESS
B
IRTH
D
ATE
N
AME OF GRA N DC HILD’S
DECEASED PARENT
________________________________
________________________________
________________________________
6. If the decedent never married and did not have any children, provide the following information on the decedent’s parents:
D
ECEDENT’S
PARENTS
P
ARENT’S NAME/
CURRENT ADDRESS
D
ATE OF
P
ARENT’S DEATH
MOTHER
________________________________
FATHER
________________________________
7. Provide the following information on the decedent’s brothers and/or sisters: (If none, indicate below.)
B
ROTHER OR SISTER NAME/
CURRENT ADDRESS
B
IRTH
D
ATE
B
ROTHER/SISTER
D
ATE OF DEATH
________________________________
________________________________
________________________________
8. Provide the following info rmation on the decedent’s nieces and/or nephews born only to the decedent’s brothers/sisters
in item 7 above: (If none, please state below.)
N
IECE OR NEP HEW NAME/
CURRENT ADDRESS
B
IRTH
D
ATE
N
IECE OR NEPHEW
DECEASED PARENTS
________________________________
________________________________
________________________________
The affiant acknowledges that he/she understands that filing a false affidavit constitutes a felony in this state.
I declare under penal ty of perjury under the law of the State of Nev a da that the foregoing is true and c o rrect.
EXECUTED this ________ day of _____________, 20_____.
BY: ______________________
(Affiant)
Notary Signature: _______________________________
My Commission expires: _______________________________
