IN THE CIRCUIT COURT OF THE SECOND JUDICIAL CIRCUIT, IN AND FOR LEON COUNTY, FLORIDA IN RE: THE ESTATE OF: PROBATE DIVISION CASE NO: Deceased. ___________________________________/ State of ____________________________ County of __________________________ For purposes of this document, you must list ALL RELATIVES (as indicated below) 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 approximate date of death. When appropriate you must indicate if the relationship is that of a half-relative (i.e. half-brother or half-sister). WHO ARE YOU? ______ 1. Name ___________________________________________________ Address and telephone number _________________________________________________________ _________________________________________________________ _________________________________________________________ I am ______ am not ______ related to the decedent as follows _______________. I have known the decedent for ____________ years. Decedent __________________________ died on ____________________. WHO IS THE DECEDENT'S SPOUSE AT THE TIME OF DEATH? ______ 2. Spouse of the Decedent. Provide name and address; or if deceased, provide name, indicate deceased, and approximate date of death. Spouse Name:_________________________________________ Address: _________________________________________ _________________________________________ _________________________________________ AFFIDAVIT OF HEIRS Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Is Spouse Deceased? ______ Yes or ______ No. Date of Death: ___________________________. WHO ARE THE DECEDENT'S CHILDREN AND GRANDCHILDREN? ______ 3.a. Children of the Decedent (Provide name and address; or if deceased, provide name, indicate deceased, and approximate 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. Children Names and Addresses: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ _______ 3.b. List the full name of grandchildren of the Decedent, making sure to provide the name of such grandchild's parents, and include the address for each grandchild. Grandchildren Names and Addresses: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ WHO ARE THE DECEDENT'S PARENTS? ______ 4. Parents of the Decedent. (Provide name and address; or if deceased, provide name, indicate deceased, and approximate date of death). ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ WHO ARE THE DECEDENT'S SIBLINGS? Siblings and descendants of deceased siblings. You must indicate whether the relationship is that of a full sibling or a half-relative (i.e. half-brother or halfsister). (Provide name and address; or if deceased, provide name, indicate deceased, and Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com ______ 5. approximate 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 __________________________ City of ___________________________ County of ________________________ Subscribed and sworn before me this ________ day of ________________. 20_____. _____ Personally known _____ Produces identification Type of identification: ________________________________ ______________________________ Notary Public or Deputy Clerk ______________________________ Print, type or stamp commissioned name of Notary or deputy clerk Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com