[Date]

[County]

[Property Address]

Introduction

I, [Your Name], being of legal age and sound mind, do hereby swear or affirm as follows:

Statement of Facts

1. I am the [Relationship to Deceased] of the deceased, [Name of Deceased], who passed away on [Date of Death].

2. The deceased, [Name of Deceased], was the owner of the following described real property located in [County], Wisconsin, more particularly described as follows:

   • [Description of Property]

3. To the best of my knowledge, information, and belief, the fair market value of the aforementioned real property at the time of the deceased's death does not exceed the threshold amount established by Wisconsin law for the use of a Transfer By Affidavit.

4. I hereby request and authorize the transfer of ownership of the aforementioned real property to myself and/or the other heirs or beneficiaries entitled to inherit the property under the laws of intestate succession or pursuant to a valid will executed by the deceased.

5. I understand that by signing this affidavit, I am affirming that all statements made herein are true and accurate to the best of my knowledge, information, and belief and that I am legally entitled to inherit the property described herein.

6. I further understand that the transfer of ownership pursuant to this affidavit is subject to any existing mortgages, liens, or other encumbrances on the property and that I assume responsibility for satisfying any such obligations.

7. I hereby indemnify and hold harmless any and all persons, entities, or officials who may rely on this affidavit in good faith, including but not limited to the register of deeds and any subsequent purchasers or encumbrancers of the property described herein.

Sworn Oath

I certify under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge, information, and belief.

[Your Name]

[Date]

NOTARY ACKNOWLEDGMENT

State of Wisconsin

County of [Your County]

On this [Date] day of [Month], [Year], before me, the undersigned notary public, personally appeared [Your Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.

Witness my hand and official seal:

[Seal]

My Commission Expires: [Date]

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