LIST OF HEIRS COMMONWEALTH OF VIRGINIA VA. CODE § 64.2-509 Court File No. ........................................................................... ............................................................................................................................................................................................................................... ..................................................................................................................... NAME OF DECEDENT Circuit Court ................................................................................................................... DATE OF DEATH I/We, the undersigned, hereby state under oath that the following are all of the heirs of the Decedent: NAMES OF HEIRS ADDRESSES RELATIONSHIP AGE ........................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................... [ ] This LIST OF HEIRS is filed in addition to the LIST OF HEIRS previously filed with this Court on I/we am/are (please check one): [ ] Proponent(s) of the will (no qualification) [ ] Personal representative(s) of the decedent's estate [ ] Heir-at-law of intestate decedent (no qualification within 30 days following death) Given under my/our hand this .............................. ................................................. . DATE day of ............................................................................................................ , DATE 20 .......................... .............................................................................................................................. PRINTED NAME OF SUBSCRIBER ________________________________________________________ SIGNATURE OF SUBSCRIBER .............................................................................................................................. PRINTED NAME OF SUBSCRIBER ________________________________________________________ SIGNATURE OF SUBSCRIBER .............................................................................................................................. PRINTED NAME OF SUBSCRIBER ________________________________________________________ SIGNATURE OF SUBSCRIBER State/Commonwealth of ................................................................. [ ] City [ ] County of Subscribed and sworn to before me this by .................. .................................................................. to wit: day of ...................................................................................., 20 .......................... ....................................................................................................................................................................................................................................................... NAME(S) ............................................................................................................................................................................................................................................................. _________________________________________________________________ [ ] CLERK [ ] DEPUTY CLERK [ ] NOTARY PUBLIC My commission expires .............................................................. Registration No................................................................................ VIRGINIA: In the Clerk's Office of the ..................................... Circuit Court this .............. day of ............................................ , 20 ........ . the foregoing LIST OF HEIRS was filed and admitted to record. Teste: _______________________________________ CLERK by: ______________________________ , Deputy Clerk FORM CC-1611 MASTER 10/12 American LegalNet, Inc. www.FormsWorkFlow.com