I, the undersigned __________________(full legal name) do hereby make
oath and say that:-
1. I reside at:
and act as ______________ (e.g. executor / administrator / heir /
survivor) of the Estate of ___________________(full legal name),
Deceased.
2. The decedent died on the _____ day of _______________ 20__. I
annex hereto, marked “A” a true copy of the Death Certificate.
3. At the time of death the decedent’s only legal address was at:
where he/she lived for a period of _______ years immediately prior to
death.
4. The decedent executed a Last Will and Testament on the ______ day
of _____________ in the year _____, revoking all previously made wills
and codicils and stating his/her address as:
5. The facts contained in this affidavit are true and correct.
___________________________________________
SIGNATURE and FULL LEGAL NAME OF DEPONENT
STATE ______________________
COUNTY ____________________
Sworn to and described before me on this _____ day of
_______________ 20___.
_____________________
NOTARY PUBLIC
My commission expires: _____________________
