Court File No. .....................................................................
AFFIDAVIT OF NOTICE REGARDING ESTATE OF ......................................................................................................................
(who died on .......................................................................................... )
I/we, the undersigned, state under oath/affirm the following:
(Check the applicable block)
1.
[ ] I/we am/are a personal representative of the estate of the deceased person named above.
[ ] I/we am/are a proponent of the will of the deceased person named above.
[ ] I/we am/are a person with an interest in the estate of the deceased person named above.
2. [ ] No notice was required to be given to any person pursuant to Va. Code § 64.2-508.
OR
[ ]
I/we mailed or delivered within 30 days of qualification (or probate) a copy of the notice required by Va. Code § 64.2-508 to the
following persons shown below
:
NAME ADDRESS WHERE MAILED OR DELIVERED DATE MAILED OR DELIVERED
a. ...........................................................................................................................................................................................................................................
b. ...........................................................................................................................................................................................................................................
c. ...........................................................................................................................................................................................................................................
d. ...........................................................................................................................................................................................................................................
e. ...........................................................................................................................................................................................................................................
(Attach additional pages if more space is needed)
(Check if applicable)
3. [ ] After exercising reasonable diligence, I/we have been unable to determine the address of the following persons to whom such
notice is required:
...........................................................................................................................................................................................................................................
...........................................................................................................................................................................................................................................
(Check if applicable)
4. [ ] After exercising reasonable diligence, I/we have been unable to identify the names and addresses of the persons described below
(such as a child of the deceased person) who may be an heir or beneficiary:
.........................................................................................................................................................................................................................................
........................................................ _______________________________________________________________________
DATE SIGNATURE
....................................................... _______________________________________________________________________
DATE SIGNATURE
Commonwealth/State of ............................................................................ [ ] City [ ] County of .............................................................................
Subscribed and sworn to/affirmed before me on this .................... day of ........................................................................... , 20 ........................
by ..................................................................................................................................................................................................................................................... .
PRI
NT NAME(S) OF SIGNATORY
...........................................................................................................................................................................................................................................................
..................................................... _______________________________________________________________________
DATE [ ] CLERK [ ] DEPUTY CLERK [ ] NOTARY PUBLIC
Notary Registration No. ......................................... My commission expires: ...............................
NOTICE: This affidavit must be recorded in the Clerk’s office where the personal representative qualified or the will was probated.
VIRGINIA: In the Clerk’s Office of the
......................................................................................................................................................... Circuit Court
this ....................... day of ................................................................................. , ............................. .
The foregoing Affidavit of Notice was this day admitted to record.
Teste:
______________________________________________________ , Clerk
by: __________________________________________________ , Deputy Clerk
FORM CC-1617 MASTER 07/17
