IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. IN THE MATTER OF THE ESTATE OF (DECEDENT): Name: Address: City, State, Zip: Date of Death: File Stamp AFFIDAVIT OF HEIRSHIP I, 1. 2. I am a of decedent. I am not related to the decedent. The source of my information is The decedent was never married. The decedent was married times and left spouse. With respect to previous marriages: Name of Prior Spouse 1. 2. 3. 3. No child was born to or adopted by decedent. The following child(ren) and no others were born to or adopted by decedent. Name of Child 1. 2. 3. 4. 5. 4. Following is information with respect to children who predeceased decedent. Name of Deceased Child 1. 2 3. 4. 5. P1-PR-009A (11/12) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com , being of legal age, certify: . as the surviving Date Marriage Terminated by Death or Dissolution By Spouse No. Minor/Disabled/Adopted Survives Decedent/Predeceased Decedent Name of each child of deceased child (Grandchild) Minor/Adopted/Disabled/ Predeceased Decedent Case No. 5. The decedent's father time(s) to the following spouse(s): decedent's father: Name of Child 1. 2. 3. 4. 5. 6. The decedent's mother time(s) to the following spouses: decedent's mother: Name of Child 1. 2. 3. 4. 5. An addendum is attached for additional information. By Spouse No. Minor/Disabled/Adopted/ Survives Decedent/Predeceased Decedent survived/predeceased decedent and she was married and the following children were born to or adopted by By Spouse No. Minor/Disabled/Adopted/ Survives Decedent/Predeceased Decedent survived/predeceased decedent and he was married and the following children were born to or adopted by Under penalties as provided by law pursuant to 735 ILCS 5/1-109, the undersigned certifies that the statements set forth in this petition are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned certifies that he/she verily believes the same to be true. Affiant: Address: City, State, Zip: Telephone No.: Attorney/Pro Se: Address: City, State, Zip: Telephone No.: Atty. Registration No.: Attorney E-mail: P1-PR-009B (11/12) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com