IN THE OFFICE OF CLERK OF JUDICIAL RECORDS

OF LEHIGH COUNTY, PENNSYLVANIA

REGISTER OF WILLS DIVISION

In re: Estate of	File No.
Deceased	Date of Death

AFFIDAVIT OF RELATIONSHIP TO DECEDENT

Commonwealth of Pennsylvania	)

) SS:

County of Lehigh	)

, being duly sworn according to law, deposes and says:

I am an adult individual who can read, write and understand the English language.

died intestate, and was a resident of Lehigh County, Pennsylvania.

I am the unrelated nominee of the decedent’s intestate heirs.

At the time of death the decedent was:

Married	Divorced	Widowed	Never married

If the decedent was married, then the spouse of the decedent is:
Name
Address
If the decedent was divorced, widowed or never married then the issue of the decedent are:

Name
Address
Name
Address
Name
Address

(If a child of decedent is applying additional documents may be required. In addition, if decedent had more than one child renunciations for children not applying are required.)

If at the time of death the decedent was not survived by a spouse nor did the decedent have any issue then decedent’s parents are:

Name
Address
Name
Address

(If only one parent is applying a renunciation from other parent is required.)

If, at the time of death, decedent was not survived by a spouse, issue or parents then decedent’s siblings are:

Name
Address
Name
Address

(If decedent is survived by more than one sibling then renunciations are required by all siblings not applying.)

further states that the above facts are true and correct.

______________________________

(Signature of person applying)

SWORN to and subscribed before

me this___________________ day of

_____________________, 20_____.

_____________________________

Notary Public or Register of Wills

Form rev 5/14

IN THE OFF OF THE CLERK OF JUDICIAL RECORDS FOR LEHIGH COUNTY, PENNSYLVANIA

Rachel A Wotring

2019-05-09

Lehigh County