State of Ohio County of Cuyahoga ) ) ) Affidavit as to Succession Under a Transfer on Death Deed (O.R.C. Section 5302.22) I,_________________________________, being first duly sworn, deposes and states as follows: That the following are the named beneficiary(s) on a Transfer on Death Deed created by: __________________________________________, who died on ___________________________, a resident of _______________________________________________________________, _________. The decedent died in __________________________________, __________ and a certificate of death was issued by the Ohio Department of Health & Vital Statistics and said certificate is attached to this Affidavit. That a "Transfer on Death Deed" was created and signed by: _______________________________________________________, and dated ___________________. Said deed was recorded on _______________________________, and is contained in Document No. _______________________________ of the Cuyahoga County Records. Legal Description ­ See Attached Property Address: __________________________________________________________________ Permanent Parcel No. __________________________________________ This Affidavit is executed to show that the title to this real estate now vests solely in the name(s) of: ______________________________________________________ ______________________________________________________ the decedents (enter relationship)__________________________________, and to enable the County Auditor's office to transfer the ownership into the name of the present sole owner and out of the name of the deceased owner, ____________________________________________. ____________________________________ Affiant SWORN TO BEFORE ME and subscribed in my presence this _____ day of _____________________, 20_____. ____________________________________ Prepared By: __________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com