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53.

Affidavit of Heirship

(Caption as in Complaint)

AFFIDAVIT OF HEIRSHIP

I, (Name of affiant), residing at (Street and number), in (City or town) , (County), (State), being of full legal age, for the purpose of establishing the legal ownership of certain land in (City or town) , (County) , (State) , proposed to be purchased by the United States of America from all the lawful heirs of (Name of (decedent)) late of (City or town), (County), (State) , who died on the day of , 19, at the age of years, a resident of (City or town), (County), (State), on oath depose and say as follows:

  1. That I was personally acquainted with the above-named decedent for the period of years from 19__, until his/her death, and that my relationship to said decedent was.

  2. That said decedent was married to (Spouse) at , in 19__, who (survived) (predeceased). (The affiant should cross out any statement enclosed in parenthesis which is not applicable to said decedent.)

  3. That the following is a list of the full names, relationships to the decedent, ages, marital status, and addresses of all surviving issue or other heirs of said decedent:

    Full Name Relationship to decedent Age Married to Address

  4. (That said decedent left no will, no issue, or no collateral heirs other than those named above and no unpaid debts or claims except as stated below.) (That I have made careful inquiry and that to the best of my information and belief said decedent left no will, no issue, or no collateral heirs other than those named above, and no unpaid debts or claims except as stated below.) (The affiant should cross out any statement enclosed in parenthesis which is not applicable. All statements made by the affiant will be considered to be made on the affiant's personal knowledge unless the contrary is expressly indicated.)

    (Unpaid debts)

  5. That the value of the decedent's entire estate at death, including all property, real and personal, then owned by the decedent, did not exceed $.

  6. That I am (not) interested financially or by reason of relationship to said decedent in the proposed conveyance to the United States of America in connection with which this affidavit is furnished, and understand that it is secured for the purpose of inducing the United States to purchase land owned by said decedent.

    There personally appeared before me the above-named , who subscribed to the foregoing affidavit and made oath that the statements contained therein are true.