In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, Illinois ESTATE OF Case No. _ Deceased AFFIDAVIT OF HEIRSffiP -SURVIVING SPOUSE OR DESCENDENT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ on oath states: 1, The Decedent~. on ~. at the age of (Date of Death) 2 I am of legal age, 1 reside at, died at _ ----Jyears, (Place of Death) ---;;;-_-,--,-.,-------;=c_----;--;;----; _ (Street Address)(City and State) I am a of the Decedent(I am not related to the Decedent), but I have knowledge of the Decedent's heirship as a result of the following: 3, D D The Decedent was never married. ---,;,,-------,----;-_---;---; (Once, twice, etc,) The Decedent was married ,and (did)(did not) leave a surviving spouse 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. o _ '----------------­ 3.. 4. D _ No child was born to or adopted by Decedent. American LegalNet, Inc. www.FormsWorkflow.com o The following children and not others were born to or adopted by Decedent: By name of chlld Minor-M Disabled-D Spouse Number 1. 2. 3. Predeceased Decedent-P Adopted-A _ _ _ 4. _ 5. _ 5. The f(}llowing is the inforn1ation with respect to each of the above children who predeceased the Decedent Name of each child of deceased childlgrandchild) Name of deceased child 1. Minor-M Disabled-D " _ h.. L. a. Predeceased Decedent-P Adopted-A _ _ _ _ _ _ a. b. _ If additional space is required, attach an addendum. If an 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 mental1)' competent, and. if children. are natural children. Affiant SUBSCRIBED AND SWORN TO BEFORE ME THIS _ _ day of ,20 _ Notary Public Atlomeys for Estate Street Address Cit)' and Slale Telephone American LegalNet, Inc. www.FormsWorkflow.com