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Fillable Printable Affidavit of Heirship - Oklahoma

Fillable Printable Affidavit of Heirship - Oklahoma

Affidavit of Heirship - Oklahoma

Affidavit of Heirship - Oklahoma

Form 119 (2013)
STATE OF )
) ss.
COUNTY OF )
AFFIDAVIT OF HEIRSHIP
Before me, the undersigned authority, personally appeared____________________________________(your
name here) being of lawful age, having been duly sworn by me upon his/her oath, and did state as follows:
1. That I am __________________________________________________ (your name here);
2. That I am actingon behalf ofthe successor(s) of the estate of _________________________ (name ofdeceased).
I was born on the day of ______________, 19 , and my socialsecurity number is ______-______-______;
3. That Ireside at __________________________________________________________________________(give
street address, city, state and zip code);
4. That the followingindividual(s) constitute the entiretyof the remainingsurvivingheirs to theestate of the
deceased and is (are) entitled to payment in the following respective proportions:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
____________________________________(provide names of heirs, their relationship(s) to deceased, age, addresses and
telephone numbers, and respective proportions--attach additional pages if needed);
5. That no application or petition for the appointment of a personal representative is pending or has been granted in
any jurisdiction regarding the estate of the deceased;
6. That all taxes and debts of the estate have been paid or otherwise provided for or are barred by limitations;
7. That the fair market valueof propertylocated in this state owned by the decedent and subject to disposition by
will or intestate succession atthe time of the decedent's death less liens and encumbrances, does not exceed Twenty
Thousand Dollars ($20,000.00);
8. That each claiming successor is entitled to payment in the respective proportions as set forth in this affidavit;
9. That Iamclaimingmoniesdue andowingthe estate of ______________________________________ (name of
deceased) from the Oklahoma Police Pension and Retirement System;
10. That Ihave obtained an estate tax identification number whichis________________________ (provide estate
tax identification number);
11. That Iagree to indemnify and hold harmless the Oklahoma Police Pension and Retirement System, its agents,
employees, officers and trustees from any and all claims of any nature whatsoever known or unknown in relation to the
payment of any monies due and owing the estate of _______________________________ (name of deceased) pursuant to
this affidavit of heirship.
FURTHER AFFIANT SAYETH NOT.
_________________________________
(date) (your signature here witnessed by notary)
ON THIS day of , 20, before me personallyappeared
___________________________________________,to me known to be the person who executed the foregoing
Affidavit of Heirship, and acknowledged that he/she executed the same as his/her free act and deed.
(seal)_____________________________________
Notary Public
My Commission Expires:_____________________ Commission No.:_____________
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