HEIRS DETERMINATION WORKSHEET A. Name of Decedent: ___________________________________ Date of Death: ___________________________________ County of Domicile: ___________________________________ Address: ___________________________________ ___________________________________ B. Name of Proposed Petitioner: __________________________________ Address: __________________________________ __________________________________ __________________________________ 3. List of heirs (Spouse and Blood Relatives Only): 1. (a) Name of decedents surviving spouse, if any (NOTE: Do not list a person from which the decedent was divorced at time of decedents death): __________________________________________ (2) If a person is named in (a) immediately above and that person has died since the decedent, show the date of death of the person named in 1(a): __________________________________________ (3) (This question relates only to the right to serve as administrator.) If there was a surviving spouse who is still alive, was anaction for divorce or separate maintenance pending between the decedent and the surviving spouse at the time of decedents death? ___________________ NOTE: IF THERE WAS A SURVIVING SPOUSE AND THERE ARE NO CHILDREN OR DESCENDANTS OF CHILDREN WHO SURVIVED THE DECEDENT, YOU MAY STOP. 2. (a) Children of decedent born in wedlock or legally adopted by decedent: Living Children Deceased Children Name Age Name DODRevised03/22/01 >>>> 2 (b) Children of decedent born out of wedlock: Living Children Deceased Children Name Age Name DODNOTE: IF ALL OF THE CHILDREN OF DECEDENT ARE ALIVE, YOU MAY STOP. 3. Grandchildren of the decedent: Living Grandchildren Name Age Parents Name Deceased Grandchildren Name DOD Parents Name NOTE: IF ALL OF THE GRANDCHILDREN OF THE DECEDENT ARE ALIVE, YOU MAY STOP. Revised03/22/01 >>>> 34. Great-grandchildren of the decedent: Living Great-grandchildren Name Age Parents Name Deceased Great-randchildreng Name DOD Parents Name NOTE: IF ALL OF THE GREAT-GRANDCHILDREN OF THE DECEDENT ARE ALIVE, YOU MAY STOP. IF THERE ARE ANY DECEASED GREAT- GRANDCHILDREN, YOU MUST ATTACH AN ADDITIONAL SHEET FOR THEIR CHILDREN. 5. Mother and father of the decedent: Name A ge Date of Death, if Deceased Mother:_________________________________________________ ________________________________ Father: _________________________________________________ ________________________________ NOTE: IF ANY PARENT IS ALIVE, YOU MAY STOP. 6. Brothers and Sisters of the Decedent: Living Brothers and Sisters Deceased Brothers and Sisters Name Age Name DODNOTE: IF ALL OF THE BROTHERS AND SISTERS OF THE DECEDENT ARE ALIVE, YOU MAY STOP. Revised03/22/01 >>>> 47. Nieces and nephews of the decedent: Living Nieces and Nephews Name Age Parents Name Deceased Nieces and Nephews Name DOD Parents NameNOTE: IF ALL OF THE NIECES AND NEPHEWS OF THE DECEDENT ARE ALIVE, YOU MAY STOP.8. Great-nieces and nephews of the decedent: Living great-nieces and nephews Name Age Parents NameRevised03/22/01 >>>> 5 Deceasedgreat-nieces and nephews Name DOD Parents Name NOTE: IF ALL OF THE GREAT-NIECES AND GREAT -NEPHEWS OF THE DECEDENT ARE ALIVE, YOU MAY STOP. 9. Grandparents of the decedent: Name Age Date of Death, if DeceasedMothers Mother: _______________________________________________________________________________Mothers Father: _______________________________________________________________________________Fathers Mother:: _______________________________________________________________________________Fathers Father: ________________________________________________________________________________NOTE: IF ANY GRANDPARENT OF THE DECEDENT IS ALIVE, YOU MAY STOP. 10. Aunts and uncles of the decedent: Living aunts and uncles Name Age Parents Name Revised03/22/01 >>>> 6 Deceased aunts and uncles Name DOD Parents NameNOTE: IF ALL OF THE AUNTS AND UNCLES OF THE DECEDENT ARE ALIVE, YOU MAY STOP.11. First Cousins of the decedent who are alive: Name Age Parents NameNOTE: IF ANY FIRST COUSINS ARE ALIVE, YOU MAY STOP. 12. The more remote degrees of kinship are determined by counting the number of steps in the chain from the claimant to the closest common ancestor of the claimant and the decedent, and from said ancestor back to the decedent. The sum of the two chains is the degree of kinship. The surviving relatives who have the lowest sum are in the nearest degree and thus inherit the estate equally. Revised03/22/01