IN THE CIRCUIT COURT, FIRST JUDICIAL CIRCUIT IN AND FOR OKALOOSA COUNTY, FLORIDA, PROBATE DIVISION IN RE: Estate of: CASE NO. ______CP __________ ________________________________ Deceased AFFIDAVIT Comes now, the Petitioner of the above entitled estate, and shows the Court as follows: 1. That the petitioner is qualified and entitled to receive the asset requested in the petition, and that At the time of death, the deceased was unmarried, and deceased had no living children, adopted or natural. 2. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of by knowledge and belief. Sworn and subscribed to before me this ________ day of ________________, 20____, who____is personally known or _______produced identification. Type of Identification produced________________________________________. Statement made before: ______________________________ (Signature) ______________________________ (Print Name) ______________________________ (Street Address) ______________________________ (City, State, Zip Code) ______________________________ (Telephone) _____________________________ (Deputy Clerk of Notary) My commission expires: American LegalNet, Inc. www.FormsWorkFlow.com