IN THE CIRCUIT COURT FOR THE FIFTH JUDICIAL CIRCUIT IN AND FOR CITRUS COUNTY STATE OF FLORIDA CASE NUMBER: IN RE: ESTATE OF / AFFIDAVIT OF HEIRS For purposes of this document, you must list ALL RELATIVES of the decedent, including yourself, if applicable. If the relative was deceased at the time of the decedent's death, please provide the deceased relative's name, indicate deceased, and date of death. Answering with n/a, not applicable, or any other such designation is inappropriate for this document; unless the decedent never had a relative within a particular category (i.e. the decedent was an only child, and therefore had no sibling(s)). When appropriate you must indicate if the relationship is that of a half-relative (i.e. half-brother or half-sister). ____ 1. Spouse of the Decedent. (Provide name, age, and address; or if deceased, provide name, indicate deceased, and date of death). ____ 2. Children of the Decedent, or descendants of deceased children. (Provide name, age, and address; or if deceased, provide name, indicate deceased, and date of death). If any of the children are NOT biologically related to BOTH the decedent and the spouse at the time of death, provide the name of that particular child's other biological parent. ____ 2a. If the surviving spouse has children who are not the children of the deceased, please indicate their name(s) ____ 3. Parents of the Decedent. (Provide name, age, and address; or if deceased, provide name, indicate deceased, and date of death). American LegalNet, Inc. www.FormsWorkFlow.com ____ 4. Siblings, and descendants of deceased siblings. You must indicate whether the relationship is that of a half-relative (i.e. half-brother or half-sister). (Provide name, age, and address; or if deceased, provide name, indicate deceased, and date of death). ____ 5. Grandparents. (Provide name, age, and address; or if deceased, provide name, indicate deceased, and date of death). ____ 6. Aunts and Uncles of the Decedent. (Provide name, age, and address; or if deceased, provide name, indicate deceased, and date of death). ____ 7. Kindred of the last deceased spouse (ONLY IF filing intestate and is not previously listed above). (Provide name, age, and address; or if deceased, provide name, indicate deceased, and date of death). Under penalties of perjury, I declare that I have read the foregoing Affidavit of Heirs and the facts stated therein are true. ________________________________ Affiant ________________________________ Print Name of Affiant ________________________________ ________________________________ ________________________________ Address of Affiant State of Florida County of ________________ Subscribed and sworn before me this _______ day of _______________________ , 20____. _____________________________ Notary Public or Deputy Clerk _____________________________ Print, type or stamp commissioned name of Notary or deputy clerk __ Personally known __ Produces identification Type of identification: _______________________ American LegalNet, Inc. www.FormsWorkFlow.com