AFFIDAVIT OF DEATH AND HEIRSHIP
DECEASED:
DATE:
SPECIFIC PROPERTY
DESCRIPTION:
SECTION/TOWNSHIP/RANGE:
COUNTY/STATE:
STATE OF ____________________ )
) Subscribed and Sworn Under Oath
COUNTY OF ____________________ )
I, __________ (first) _____(MI) __________________(last), the affiant (“I” or “my” hereinafter), being of lawful age,
being first duly sworn, upon oath deposes and states:
I was well acquainted with the above named deceased individual (“deceased” hereinafter) for _____ number of years
and the answers and statements given in the following questionnaire are based upon my personal knowledge, true,
and correct. Further, I am not a direct heir of the named deceased individual.
1. What was your relationship to the deceased? ________________________________
2. The deceased departed his/her life on __________ (month) ______ (day), _________(year) in
__________________ (county or city), _____________________ (state). He/She was ________ years old.
3. The deceased owned the mineral property listed in the reference boxes above. YES / NO (circle one)
4. The described property was / was not (circle one) occupied by the deceased individual as his/her
homestead.
5. The described property is / is not (circle one) occupied by the deceased’s surviving spouse.
6. The described property was property acquired by the deceased before / during (circle one) his/her most
recent marriage.
7. How was the described property acquired by the deceased? (circle one) Inherited / Purchased / Gifted
I was well acquainted with the deceased’s surviving family members, and the following statements and answers to
the following questions are based upon my personal knowledge and are true and correct:
8. Did the deceased leave a will? YES / NO (circle one)
9. In what states has the deceased's estate been probated? (if no probate, write "none")
_________________________________________________________________
10. The estate of the deceased currently DOES / DOES NOT (circle one) owe and debts to any person, business,
or government entity, including any state or federal taxes.
11. If you circled DOES on question 10, please describe all debts owed, including taxes, of the estate:
______________________________________________________________________________________
12. At the time of death, the deceased was MARRIED / WIDOWED / DIVORCED / SINGLE-NEVER MARRIED
(circle one)
13. If you circled married, what was the deceased’s surviving spouse’s name? __________________________
14. If you circled married, what is the address of the surviving spouse?
______________________________________(street) ________________________(city) ________(state)
15. How many times was the deceased married? 0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8+ times (circle one)
16. What are the names of all surviving and former spouses, and list how many children, including adopted, the
deceased had with each spouse.
Name of Spouse
Date of Divorce (if applicable)
Number of children, including adopted
17. What is the total number of the deceased’s children, both natural and adopted? _________________
18. Complete the following information concerning all children born or adopted to the deceased, who were
living at the time of the deceased’s death.
Name of Son or Daughter
Date of Birth
Present Mailing Address
19. Complete the following information concerning all children born or adopted to the deceased, who were not
living at the time of the deceased’s death.
Name of Son or Daughter
Date of Birth
Other Parent
Date of
Death
Please complete an Affidavit of Death and Heirship for each deceased child that was listed on question 19.
20. If the deceased left no surviving spouse or children, give the following information in the following order:
1- the parents of the deceased, 2- if the parents are not living, the brothers and sisters of the deceased
(including those that have passed away), 3- the children of the departed brothers and sisters listed, 4- if no
parents, brothers, sisters, nieces, or nephews, list the aunts and uncles of the deceased, 5- if none of the
above, the next of kin of the deceased.
Name / Relationship
Date of Birth
Address / (if departed, state the date of
death)
I am aware of the penalties of perjury under Federal Law, which includes the execution of a false affidavit,
pursuant to 18 U.S.C.S., Section 1621 wherein it is provided that anyone found guilty shall not be fined more than
$2,000 or imprisoned not more than 5 years or both. I am also aware that under Section 393 of the Oklahoma
Statutes Annotated, a person who knowingly submits and signs a false affidavit shall be fined up $3,000 or
imprisoned up to 6 months and shall make restitution of the amount fraudulently attained to the rightful
beneficiary.
____________________________________________
Signature of Affiant
TO BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC
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ACKNOWLEDGMENT OF THE AFFIANT’S ABOVE AFFIDAVIT
STATE OF ___________________ )
) Subscribed and Sworn Under Oath:
COUNTY OF _________________ )
Subscribed and sworn to be this __________ day of ______________, 20_____.
Notary Public Signature
Commission number
My Commission expires: _____________________, 20_____.
CONFIRMATION OF AFFIDAVIT OF DEATH AND HEIRSHIP
(to be signed by a person other than the one making the foregoing affidavit and who is not a named heir or a family
member of an heir)
I, __________ (first) _____(MI) __________________(last), the confirming affiant, being of lawful age, being first duly
sworn, upon oath deposes and states:
The information given in the above and foregoing affidavit is true, and accurate, to the personal knowledge of this
confirming affiant.
_____________________________________________
Signature of Confirming Affiant
TO BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC
ACKNOWLEDGMENT OF THE CONFIRMING OF AFFIDAVIT
STATE OF ___________________ )
) Subscribed and Sworn Under Oath:
COUNTY OF _________________ )
Subscribed and sworn to be this __________ day of ______________, 20_____.
Notary Public Signature
Commission number
My Commission expires: _____________________, 20_____.
Notices Regarding the Affidavit of Death and Heirship
NOTE: This form may be signed by a member of the family, as long as they are not an heir to the deceased, but the
Confirming Affidavit MUST be signed by a person who is NOT a member of the family or a direct heir. This form
must be notarized for the AFFIANT and the CONFIRMING AFFIANT.
NOTE: If the deceased left a will, and the will was NOT probated in the state where the land/minerals are located,
the laws of Intestate Descent and Distribution of that state will apply, and NOT the terms of the will.
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