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Affidavit Regarding Heirship No Descendants-November 2012 ELEVENTH JUDICIAL CIRCUIT COURT IN RE: THE ESTATE OF ) ) Case Number: Deceased. ) AFFIDAVIT OF HEIRSHIP COLLATERAL HEIRS (NO DESCENDANTS) on oath states: 1. The Decedent, died on at the age of 2. I am of legal age, I reside at I am a (relationship) of the Decedent. I am not related to the Decedent, but have knowledge of Decedent’s heirship as a result of the following: _ 3. The Decedent was never married. The Decedent was never a party to a civil union. The Decedent was married (number of marriages). The Decedent was a party to a civil union (number of civil unions). The following is information with respect thereto: Name of Spouse/Civil Partner Marriage/Civil Partnership Terminated Predeceased (By death or dissolution) Decedent - P 4. No child was born or adopted by the Decedent. The following children, and no others were born to, or adopted by the Decedent, all of whom predeceased Decedent: ---PAGE BREAK--- Affidavit Regarding Heirship No Descendants-November 2012 Name Date of Death 5. The Decedent’s parents were: Father, who (survived) (predeceased) Decedent. And Mother, who (survived) (predeceased) Decedent. 6. The following children, and no others, were born or adopted by Decedent’s parents: Names of Brother(s) or Sister(s) Predeceased - P 7. Those brothers and sisters who predeceased the Decedent and who had children born or adopted: By Brother or Name of Niece or Nephew Sister Letter Predeceased - P 8. Those nieces and nephews who predeceased the Decedent and who had children born or adopted: By Niece or Name of Great Niece or Nephew Nephew Letter Predeceased - P ---PAGE BREAK--- Affidavit Regarding Heirship No Descendants-November 2012 9. Based on the foregoing, Decedent left surviving as his or her heirs the following, all of whom survived the Decedent, and in the absence of any indication of the contrary, are of legal age and mentally competent. Name Relationship to Decedent (Trace Relationship) Date Affiant Subscribed and sworn to before me this Circuit Clerk or Notary Public PRO SE Attorney Attorney Telephone