IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS Probate Division Estate of ) ) ) ) ) _______________________________________ Deceased Case Number_____________________________ AFFIDAVIT OF HEIRSHIP _____________________________________________________, under the penalties of perjury states: (Affiant's name) 1. The Decedent, ________________________, died at ____________________________, Illinois on __________________, at the age of ______years, who had _________ children born or adopted. (date) (state relation to Decedent) (number) 2. I am of legal age, I am ________________________________of the Decedent. I reside at _______________________________________, Illinois. 3. Decedent was married to _____________________________________________________________________, (a) who is living, and is Decedent's surviving spouse. (b) which marriage ended in divorce. (copy of OUT OF COUNTY JUDGMENT attached) (c) who pre-deceased decedent on ___________________________________. ________________ children were born or adopted of said marriage. (number of children) 4. Information on living children: Name Age Address Other Parent's Name 5. Information on pre-deceased children: Age at Name Death Number of children born or adopted of said Child Other Parent's Name 6. Children born or adopted of a deceased child: Grandchild's Name Age Address Parent's Name (Decedent's Child) PR-AFF1: Revised 12/01/06 Page 1 of 2 Estate of Deceased American LegalNet, Inc. www.FormsWorkflow.com 7. Complete this section if Decedent died without surviving spouse or living descendants. Parents The Decedent's mother was _________________________________, who ____________________ the Decedent. (survived) (pre-deceased) The Decedent's father was __________________________________, who ____________________ the Decedent. (survived) (pre-deceased) Brothers and Sisters The Decedent had the following brothers and sisters: Name Age Address Survived or Pre-Deceased Number of Children Children of a Deceased Sibling The Decedent had the following nieces and nephews born or adopted of a deceased sibling. Survived or Name Age Address Pre-Deceased Parent's Name (Decedent's sibling) 8. Other information as to heirs, if needed: Name Age Relationship Address Parent's Name 9. Except as otherwise herein specifically mentioned and set forth, there were no adoptions and no child(ren) born out of wedlock known to affiant. 10. Based on the foregoing, Decedent left surviving, as Decedent's only Heirs, the following, all of whom survived Decedent, and in the absence of an indication to the contrary, are of legal age and mentally competent: (Disabled - D; Minor - M) Name Relationship Name Relationship THE UNDERSIGNED states under oath that the above is true and accurate to the best of his/her knowledge. _______________________________________________ Affiant Name_____________________________________ Attorney for________________________________ Address___________________________________ City, State Zip______________________________ Telephone_________________________________ Subscribed and sworn to before me this ________ day of ____________________,20___ ________________________________________ Notary Public PR-AFF1 PR-AFF1: Revised 12/01/06 Page 2 of 2 Estate of Deceased American LegalNet, Inc. www.FormsWorkflow.com