Document prepared by (after recording return to): Name: Address: --Above this line reserved for official use only-- The Heirship Affidavit must not be signed by a beneficiary or other person who has an interest in the estate of the the Deceased. HEIRSHIP AFFIDAVIT STATE OF ARIZONA COUNTY OF _________________________ INFORMATION CONCERNING ________________________________________ [name of the Deceased person], DECEASED. BEFORE ME, the undersigned authority, on this day personally appeared ________________________________________, the Affiant, who is personally known to me (or, if not personally known to me, did confirm his/her identity presenting ________________________________________________________ as identification), and appearing to be fully competent and of sufficient age, being first duly sworn according to law, stated upon the Affiant’s oath the following: A. My name is ________________________________________ and I reside at ___________________________________________________________ [address], _____________________ [city], State of __________________. B. I was personally well acquainted with the Deceased during his/her lifetime, having known him/her for ________ years. My relationship with the Deceased was as follows: _______________________________. [Indicate the relationship, e.g. friend, cousin, etc.] C. I am personally familiar with the family and marital history of the Deceased and have personal knowledge of the facts stated in this Affidavit. D. The Deceased passed away at _______________________ [city/town] in _____________________ County/Parish, State of __________________________, on or about _________________, 20_____ [date of death], being ___________ years old at the date of his/her death. E. At the time of his/her death, the Deceased resided at ________________________________________________________________________ [address], _________________________ [city], Arizona. F. I was well acquainted with the family and nearest relatives of the Deceased, and with all those persons who would be his/her heirs under the laws of the State of Arizona. Affiant further states that the statements hereinafter set forth, including answers to questions posed, are based upon the Affiant’s personal knowledge and are true and correct. -2- 1. Did the Deceased leave a Will? __________ 2. If the Deceased left a Will, has the Will been admitted to probate? If yes, give the date and the location of the court: Date: _____________________________ Cause Number:___________________________ Location: __________________________________________ County, Arizona 3. If the Deceased did not leave a Will, has an administrator or personal representative been appointed for the estate of the Deceased? ____________________________ THIS IS A 4-PAGE FORM.