AFFIDAVIT OF HEIRSHIP - (SPOUSE AND/OR DESCENDENTS) - PROBATE STATE OF ILLINOIS UNITED STATES OF AMERICA IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT 3842-1(Rev. 06/06) COUNTY OF DU PAGE IN RE THE ESTATE OF CASE NUMBER DECEASED File Stamp Here AFFIDAVIT OF HEIRSHIP SPOUSE AND/OR DESCENDENTS The undersigned, on oath states: 1. The decedent, died on 2. I am of legal age, I reside at I am a Relationship at at the age of of the decedent. I am not related to the decedent, but have knowledge of decedent's heirship as a result of the following: 3. The decedent was never married The decedent was married Number of Marriages The following is the information with respect hereto: Name of Spouse Marriage Terminated (by death or divorce) Predeceased Decedent - P 1. 2. 3. 4. No Child was born or adopted by the Decedent. The following children and no others were born to or adopted by decedent. (List children on page 2 of this form.) CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60189-0707 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com AFFIDAVIT OF HEIRSHIP - (SPOUSE AND/OR DESCENDENTS) - PROBATE 3842-2 (Rev. 06/06) 5. Name of Child By Spouse Number (Section 3) Minor - M Disabled - D Adopted - A Predeceased P Spouses Name if Married 1. 2. 3. 4. 6. The above (section 5) is information with respect to each of the above name children who predeceased the decedent. Deceased Child (Section 4) Name of each Child of Deceased Child (Grandchild) Minor - M Disabled - D Adopted - A Predeceased P 1. 2. 3. 4. 7. The above (section 6) is the information with respect to each grandchild of the decedent who predeceased the decedent. Deceased Grandchild (Section 5) 1. 2. 3. 4. Name of each Child of Deceased Grandchild (Great-Grandchild) Minor - M Disabled - D Adopted - A Predeceased P Based on the foregoing, decedent left surviving as his or her heirs the following, all of whom survived the decedent, and in the absence of any indication of the contrary, are of legal age, are mentally competent, and if children, are natural children. Date Affiant Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: PRO SE Subscribed and sworn to before me Date Circuit Clerk or Notary Public CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60189-0707 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com