Affidavit Of Survivorship

AFFIDAVIT OF SURVIVORSHIP

STATE OF ____________________
COUNTY OF ____________________

I, ____________________, residing at ____________________, in the county of ____________________ in the state of ____________________ and being duly sworn, do hereby depose and attest that:

1. The Decedent, ____________________, is named in the attached death certificate.
2. The Decedent died on ____________________ and {was/was not} legally married at the time.
3. The names of the Decedent's survivors are ____________________
4. My relationship to the Decedent was ____________________
5. At the time of death, the Decedent was the joint owner of ____________________ along with ____________________
6. The property is legally described as follows: ____________________

____________________
AFFIANT

Subscribed and sworn to before me this ____________________ day of ____________________ 20 ____________________

____________________
(Notary Public),

____________________ County.

My commission expires ____________________ 20 ____________________