Fillable AFFIDAVIT OF HEIRSHIP

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AFFIDAVIT OF HEIRSHIP

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53-111-A
(Rev.5-20/5)
AFFIDAVIT OF HEIRSHIP
THIS AFFIDAVIT MUST BE FILED
WITH THE COUNTY CLERK
The claimant must le this completed adavit in the County Clerk’s record in the county of the decedent’s residence.
The claimant must then upload a le stamped copy of the completed adavit to ClaimItTexas.org.
.
Name of Claim
reported owner: number:
Adavit of facts concerning the identity of heirs for the estate of ________________________________________________________
NAME OF DECEASED PERSON (DECEDENT)
Before me, the undersigned authority, on this day personally appeared: ___________________________________________________
who, being rst duly sworn, upon his/her oath states:
PERSON COMPLETING THIS FORM (WITNESS)
SECTION A. WITNESS INFORMATION
If additional space is needed for any of the elds below, please provide an attachment with the additional information.
1. My name is: _____________________________________________________________________________________________
My current address is: _____________________________________________________________________________________
I have personal knowledge of the family history and facts of heirship of: ________________________________________________
NAME OF DECEASED PERSON (DECEDENT)
True
I am not the claimant, and I will not benet from the decedent’s estate.
The decedent was my _______________. I knew the decedent for ______ years.
RELATIONSHIP
SECTION B. DECEDENT INFORMATION
2. Decedent died on __________________________________________________________________________________________
DATE OF DEATH
Decedent's residence at the time of decedent's death: ______________________________________________________________
CITY STATE COUNTY
Decedent left a will:
No
If yes, this form is not required, and the claimant should contact our ofce at 1-800-321-2274.
Yes
SECTION C. MARITAL AND FAMILY HISTORY
3. At the time of decedent’s death, decedent was:
Never married Married Divorced/widowed
List all marriages, including those that ended in divorce or death. Mark N/A if not applicable
NAME OF SPOUSE
DATE OF
MARRIAGE
DATE OF
DIVORCE
DATE OF
SPOUSE'S DEATH
CURRENT ADDRESS
4. Did the decedent have any children (biological or adopted)?
No
If yes, complete information below. If no, proceed to #6
Yes
NAME OF CHILD
DATE OF
BIRTH
NAME OF CHILD'S
OTHER PARENT
CURRENT ADDRESS
5. Are any of the children listed in #4 deceased?
No
If yes, complete information below. If no, proceed to Section D – Attestation
Yes
DECEASED CHILD INFORMATION CHILDREN OF DECEASED CHILD
NAME OF
DECEASED CHILD
DATE OF
DEATH
SURVIVING SPOUSE
NAME (IF APPLICABLE)
IS SPOUSE
ALIVE? Y/N
CHILD
IS CHILD
ALIVE?Y/N
CHILD'S OTHER PARENT
(IF KNOWN)
_____________________________________________________________________
____________________________________________________________________________
Form 53-111-A(Back)(Rev.5-20/5)
Name of Claim
reported owner: number:
6. Did the decedent have:
Yes No
a. A surviving spouse at time of death?
Yes No
b. Surviving children or children’s descendants at time of death?
If yes to at least one of the above, proceed to Section D - Attestation
7. Provide the following information on the decedent's parents:
NAME OF PARENT
IS THIS PARENT
DECEASED?
IF YES, PROVIDE
DATE OF DEATH
CURRENT ADDRESS
8. Are either of the decedent’s parents deceased?
No
If yes, complete information below. If no, proceed to Section D – Attestation
Yes
9. Did the decedent have siblings?
No
If yes, complete information below. If no, proceed to Section D – Attestation
Yes
NAME OF SIBLING
CURRENT ADDRESS
DATE OF
BIRTH
SIBLING MOTHER
NAME
SIBLING FATHER
NAME
10. Are any of the siblings listed in #9 deceased?
No
If yes, complete information below. If no, proceed to Section D – Attestation
Yes
DECEASED SIBLING INFORMATION CHILDREN OF DECEASED SIBLING
NAME OF
DECEASED SIBLING
DATE OF
DEATH
SURVIVING SPOUSE
NAME (IF APPLICABLE)
IS SPOUSE
ALIVE? Y/N
CHILD
IS CHILD
ALIVE?Y/N
CHILD’S OTHER PARENT
(IF KNOWN)
**Section D must be completed in front of a notary public**
SECTION D. ATTESTATION
I swear under penalty of perjury that the foregoing is true, accurate, and complete to the best of my knowledge.
Signed this __________day of ___________ , ______________________________ .
(SIGNATURE OF WITNESS BEFORE NOTARY)
State of __________________________ County of _____________________________________________
Sworn to and subscribed to before me on __________________________________
(DATE)
by ____________________________________________________________________________________
(PRINTED WITNESS NAME)
(NOTARY SIGNATURE)
(Notary Seal)
My commission expires: __________ day of __________ , ____
.
The claimant must le this completed afdavit in the County Clerk's record in the county of the decedent's residence. The claimant must then
upload a le stamped copy of the completed afdavit to ClaimItTexas.org.
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AFFIDAVIT OF HEIRSHIP

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Completed 30 June 2022

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