STATE OF __________________ )Title Order Number: ________________
)
COUNTY OF ______________ )
_____________________________________________ , being first duly sworn, on oath deposes and says:
That Affiant is the surviving spouse of ________________________________
who died at ___________________________, on the ________________________ day of ___________________________________ in ____________________ County, State of __________________________. A copy of the death certificate is attached hereto.
That among items of community property was real estate described in the above referenced title order.
CHECK WHICH APPLIES:
______ The Affiant and the deceased acquired said property as community property under deed dated
___________ and recorded under ____________________ County recording
number ___________________ OR;
______ The Affiant and the deceased provided for the conversion of separate property to community property
by deed dated ________________, and recorded under ______________ County recording
number __________________ OR ;
That Affiant and the deceased provided for the conversion of separate property to community property
and for the disposition of all community property by Community Property Agreement dated
________________, and recorded under ____________________ County recording
number ________________________.
That there are no unpaid creditors of said decedent or of the former marital community nor unpaid funeral expense, or expenses of last illness, except as follows:
CHECK WHICH APPLIES:
______ That the decedent left a Will, a copy of which is attached hereto.
______ That the decedent left no Will.
______ That the decedent's estate is not being probated.
______ That the decedent's estate is subject to probate proceedings in __________ ______ County,
State of _______________, under No. ___________________
That the value of the decedent's estate at the date of death, including all real and personal property, was approximately $ __________________, including the value of all separate property of said decedent of approximately $ ________________, and including the value of the decedent's community estate of approximately $ ___________________
This affidavit is made to induce you and Stewart Title Guaranty Company to issue its policies of title insurance on real property passing to the surviving spouse because it was community property or passing to the surviving spouse because it was separate property of the deceased which was converted to community property by said community property survivorship agreement or deed identified herein, all in reliance upon the representations set forth herein.
Dated: __________________________________
_____________________________
(Affiant Full Name)
__________________________________________
__________________________________________
__________________________________________
(Full address and telephone number)
STATE OF WASHINGTON )
ss.
COUNTY OF __________________ )
On this _____________ day of ___________________, ______ before me, the undersigned, a notary public in and for the State of Washington, duly commissioned and sworn, personally appeared ________________________________________ known to me to be the individual(s) described in and who executed the within instrument and acknowledged that _______ signed and sealed the same as _______ free and voluntary act and deed, for the uses and purposes herein mentioned.
____________________________________
Notary Public
Printed Name: _____________________
My appointment expires: _____________
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