Name of Declarant *

Name of person that will be signing the Affidavit

First Name

Last Name

Phone Number Declarant *

(###)

###

####

Return Mailing address *

Address where Affidavit will be mailed after recording.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tax Statements Mailing Address

Address where Property Tax Bills will be mailed, if different than above address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Deceased *

First Name

Last Name

Date of Death *

Date of Death of Decedent

MM

DD

YYYY

Name of Requester

Name of person requesting Affidavit, if other than Declarant.

First Name

Last Name

Signing Address

Address Where Documents will be signed, if Full Service requested.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Property Address *

Address of Subject Property

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country