In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, Illinois ESTATE OF Case No. Deceased _ AFFIDAVIT OF HEIRSHIP -NO SURVIVING SPOUSE OR DESCENDENT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ on oath states: 1. The Decedent, on (Date of Death) 2.1 am oflegal age, I reside at. at the age of ~, died at ----Jyears. (Place of Death) _ ---"o-_.,..-,-.,-------,,~-_;_;;__;_----------- (Street Address)(City and State) 1 am a of the Decedent(l am not related to the Decedent), but 1have knowledge of the Decedent's heirship as a result of the following: 3. 0 The Decedent was never married. The Decedent was married, (Once, twice, etc.) but left o no survtvmg spouse. The following is the information with respect to each marriage: Name of Spouse 1 2. _ Marriage terminated by death or Dissolution (give app. dates) _ 3. _ o 4. The Decedent left no surviving natural or adopted Descendent. A. The Decedent's father ---,and he _ (name) (is)(was) (name) --,-="'~--,-==_=,-------Decedent. The Decedent's mother---,,'=7::=,---(survlved)(predeceased) (ls)(was) andshe _ _ _ _ _ _ _Decedent. t,ime(s) to the following spouse(s): (survived)(predeceased) B. Decedent's father was married, American LegalNet, Inc. www.FormsWorkflow.com Decedent's mother was married, tirne(s) to the following spouse(s): C. The following children were born to or adopted by Decedent's father: Spouse Number Minor-M Disabled-D Adopted-A Predeceased Decedent-P Name D. Tne following children were born to or adopted by Decedent's mother: Spouse Number Minor-M Disablcd-D Adopted-A Predecea'ed Decedent-P Name If any brother or sisters (including half blood) are deceased, state their descendants in an addendum. If parents, brothers, sisters, and their descendants are all deceased, prepare addendum starting with paternal and maternal grandparents. Refer to any addenda here. All of the above in the absence of an indication to the contrary survived the Decedent, are oflega] age, are mentally competent, and, if children, are natural children. Affiant SUBSCRIBED AND SWORN to before me this _ _ day of _ ,20 . Notary Public American LegalNet, Inc. www.FormsWorkflow.com