STATE OF OHIO COUNTY OF GEAUGA AFFIDAVIT OF SURVIVING SPOUSE OR JOINT SURVIVORSHIP O.R.C. 5302.17 __________________________________, being first duly sworn, deposes and says: 1) That she/he __________________________ and ______________________are joint owners of property under a duly recorded survivorship or tenancy by entireties deed. 2) Said property is known as ___________________________________________, Street Address _______________________________, Geauga County, State of Ohio, and is further Township/Village described as Permanent Parcel # ________________ on the records of the Geauga County Auditor. A full legal description of said property is stated in the survivorship or entireties deed which is recorded in the records of the Geauga County Recorder in Volume __________, Page __________, and a copy of the legal description which is attached hereto.* 3) That _______________________________________________ died on or about _______________________, 2____, at _______________________, ___________, and said certificate of death is attached hereto. 4) That by virtue of the death of the party listed in Item #3 above, she/he is the fee simple owner of the above described property. *Excepting: ___________________________________ Sworn to and subscribed before me this ______ day of _______________, _______. ___________________________________ Notary Public Prepared by: __________________________ Address: _____________________________ _____________________________________ Rev 2/2000 American LegalNet, Inc. www.FormsWorkflow.com