IN THE CIRCUIT COURT FOR THE TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS IN THE MATTER OF THE ESTATE OF __________________________________ Deceased Case No.___________________________ AFFIDAVIT OF HEIRSHIP ­ NO SURVIVING SPOUSE OR DESCENDANT ____________________________________________________________ on oath says: 1. The Decedent, ___________________________________, died at _____________________________ (place of death) on ____________________________________ at the age of _________________years. (date of death) 2. I am of legal age. I reside at ________________________________, ___________________________. (street address) (city and state) I am a _________________________ of the Decedent. (state relationship) I am not related to Decedent, but I have knowledge of the Decedent's heirship as a result of the following: 3. A. B. The Decedent was never married. The decedent was married ____________________ and (did) (did not) leave a surviving spouse (once, twice, etc.) whose name is _____________________________. The following is the information with respect to each marriage of Decedent: Marriage terminated by death or dissolution (give app. dates) Name of Spouse 1. 2. 3. 4. A. B. Name of Child 1. 2. 3. 4. 5. Probate17\Affidavit of Heirship-No Surviving Spouse or Descendant 11/19/2012 No child was born to or adopted by Decedent. The following children and no others were born to or adopted by Decedent. By Spouse Number Minor or Disabled Adopted Predeceased American LegalNet, Inc. www.FormsWorkFlow.com 5. The following is the information with respect to each of the above children who predeceased the Decedent: Name of each Name of Child of deceased Deceased Child Child (grandchild) Minor or Disabled Adopted Predeceased 1._______________________ a.______________________ b.______________________ 2._______________________ a.______________________ b.______________________ If additional space is required, attach an addendum. If additional generation is required, or other data is required, attach an addendum and refer to it here. All of the above in the absence of an indication to the contrary, are of legal age, are mentally competent and, if children, are natural children. ___________________________________ Affiant Attorney for Estate: Street Address: City and State: Phone: NOTE: This form is provided as a convenience and guide. It is not intended to cover all possible heirship situations. Subscribed and Sworn to before me this _____ day of _______________, 20 _____ ___________________________________ Notary Public Probate17\Affidavit of Heirship-No Surviving Spouse or Descendant 11/19/2012 American LegalNet, Inc. www.FormsWorkFlow.com