___________________________________________________________________________________________________ Preparer Information: (Name, Address & Phone Number) ____________________________________________________________________________________________________ Taxpayer Information: (Name & Complete Address) ____________________________________________________________________________________________________ Return Document To: (Name & Complete Address) Affidavit of Surviving Spouse for Change of Title to Real Estate STATE OF IOWA, POLK COUNTY, I, _______________________________________________, being first duly sworn on oath, depose and state as follows: 1. I am the surviving spouse of ______________________________________, who died on the _____, day of ___________, ___________in _________________________, _________________________, _______________________. Year City County State 2. The following described real estate was owned by ___________________________, and __________________________ as joint tenants with full rights of survivorship as shown on the records of the Polk County Recorder by deed recorded on the ________ day of ____________, __________, in Book _____________ Page _____________, that said property was owned as joint tenants with full rights of survivorship at the time of _____________ death. (His/Her) 3. I hereby request that the auditor enter this information on the transfer books pursuant to section 558.66 of the Code of Iowa. Legal Description of Property: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Signed this _________ day of ________________, __________. X____________________________________________________. X ___________________________________________________. (Print Name) Subscribed in my presence and sworn to before me by the said __________________________________________________ this _______________ day of ___________________, ____________. X __________________________________________ Notary Public in and for ______________, _____________. *PURSUANT TO SECTION 558.66, THE AFFIDAVIT APPLIES ONLY WHEN DESCENDANT DIED ON OR AFTER JANUARY 1, 1988. American LegalNet, Inc. www.FormsWorkFlow.com