Affidavit of Survivorship Template

This Affidavit of Survivorship (the “Affidavit”) is made on [Date] by:

Affiant / Surviving Owner: [Full Name], address: [Address], phone/email: [Contact].

Deceased Owner: [Full Legal Name]
Date of Death: [Date]
Place of Death (City/State): [City/State]

1. Purpose

1.1 I am making this Affidavit to confirm that I am the surviving joint owner and to help update records for the property/account described below.

2. Joint Ownership and Survivorship

2.1 The deceased owner and I held title/ownership as:
☐ Joint tenants with right of survivorship
☐ Tenants by the entirety (if applicable)
☐ Other survivorship form permitted by law: [Describe]

2.2 To the best of my knowledge, I am the surviving owner and the survivorship right applies to the property described below.

3. Property / Account Information

3.1 Real Estate (If Applicable):

• Property address: [__]

• County/State: [__]

• Legal description (optional): [__]

• Recording reference (optional): [Instrument # / book & page]

3.2 Financial Account (Optional):

• Institution: [Bank/Broker]

• Account number (last 4 digits only): [____]

4. Death Certificate and Attachments

4.1 A certified copy of the death certificate is: ☐ attached ☐ will be provided.
4.2 Other attachments (optional): ☐ deed/title copy ☐ account statement ☐ proof of identity ☐ other: [List]

5. Statement Under Oath

5.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.

Signatures

Affiant / Surviving Owner: [Full Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (If Required)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________