State of )
TITLE ORDER NUMBER: _____________
County of )
__________________________________________________, being first duly sworn, on oath deposes and says:
That Affiant is one of the joint tenants named in that certain instrument creating a joint tenancy dated
___________________, and recorded _________________, under auditors file number
That affiant and __________________________________________________ ___________________________________________________________ (list here all joint tenants ) are the same persons who are the joint tenants named in said instrument.
That _____________________________ of __________________________ who died at __________________, on the _________________ day of ____________, _____
in _______________ County, State of __________________, then being a resident of
________________, County of ____________________, State of _______________ is the same person as one of the joint tenants named in said instrument. A copy of the death certificate is attached hereto.
That Affiant has herein below identified each and all of the heirs at law of decedent, including but not limited to children, adopted children, and the issue of any predeceased child or adopted child (if decedent left no surviving children, then Affiant has listed below all of the surviving parents, brothers and sisters of decedent).
That the heirs at law of the decedent are (list all of the heirs at law, using the reverse side or attaching a list if necessary):
That Affiant knows of his/her) own knowledge, and so states, that each and all of the obligations against the estate of said decedent (including, but not limited to: all the debts of decedent; all of the expenses of decedent's last illness, funeral and burial; promissory notes; installment contracts and mortgages; and state and federal succession taxes upon decedent's estate, if applicable) have been paid in full, except as follows (use reverse side or attach a list if necessary);
CHECK WHICH APPLIES:
______ That the decedent was married to _______________________ on the date of said
instrument and on date of death.
______ That the decedent was not married on the date of said instrument, but was married to ______________
________________________ on date of death
______ That the decedent was not married on the date of said instrument or on the date of death nor at any
time between those dates.
______ That the decedent was not married on date of said instrument nor date of death, but was married to
_________________________________________ between said dates
______ That the decedent left no Will.
______ That the decedent left a Will, a copy of which is attached hereto.
______ 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 estate of the decedent is exempt from State and/or Federal succession or inheritance taxes.
______ That State and/or Federal succession or inheritance taxes in the amount of $_____
have been paid. Copies of the release/discharge is attached hereto.
______ That State and/or Federal succession or inheritance taxes are due, but have not been paid.
______ That all creditor's claims against the estate of the decedent have been paid.
That the value of the decedent's estate as of 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 $ __________________.
That at all times from the execution of the instrument above described to the death of said decedent each of the joint tenants recognized that the above described property was held in joint tenancy; that the interest of no one or more of said joint tenants has ever been conveyed, encumbered or otherwise separated from the interest of the other joint tenant(s), either voluntarily or involuntarily, whether by specific act or by operation of law.
That said joint tenancy continued in force until the death of the said decedent with respect to the interest of the decedent and, if there are two or more surviving joint tenants, including Affiant, continues in force with respect to the interests of said surviving joint tenants.
This affidavit is made to induce you and Stewart Title Guaranty Company to insure real property covered by the Company's order number set forth above, in which decedent held an interest at the time of his (her) death. Affiant urges Company to issue its policy of title insurance in full reliance upon the representations set forth herein. The affiant, for ____________ self, _______________ heirs, executors and administrators, covenants to indemnify any such purchaser, title insurer or other person for any loss arising from reliance on a misstatement of fact herein.
(Affiant's Full Name)
(Full address and telephone number)
STATE OF WASHINGTON )
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.
Printed Name: _____________________
My appointment expires: _____________
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