COMMONWEALTH OF VIRGINIA

County of [COUNTY]

Introduction:

I, [YOUR NAME], residing at [YOUR ADDRESS], being duly sworn, declare under oath as follows:

Statement of Facts:

1. The decedent, [Decedent's Name], passed away on [Date]. At the time of death, their place of residence was [Decedent's Address]. This information is essential for processing any claims or legal matters related to the decedent's estate.

2. I am the successor of the decedent (e.g., heir, beneficiary) and entitled to payment or delivery of the property of the decedent. My relationship to the decedent is: [Your Relationship to the Decedent].

3. To the best of my knowledge, the value of the entire personal estate of the decedent, wherever located, less liens and encumbrances, does not exceed $50,000, the statutory limit for small estates in Virginia.

4. The names and addresses of the surviving spouse, if any, and all heirs of the decedent are:
   Surviving Spouse:

   • Name: [Spouse's Name]

   • Relationship: Spouse

   • Address: [Spouse's Address]

   Heirs:

   • Name: [Heir 1's Name]

   • Relationship: [Relationship to Decedent]

   • Address: [Heir 1's Address]

   • Name: [Heir 2's Name]

   • Relationship: [Relationship to Decedent]

   • Address: [Heir 2's Address]

   I understand that I am entitled to payment or delivery of the property of the decedent, subject to the decedent's debts and claims against the estate.

5. The specific property to be transferred is as follows:

   • Bank Account: Account Number XXXXXXXXX at [Bank Name], containing $[Amount].

   • Real Estate: The property located at 1234 Oak Street, Anytown, USA, described as Lot 567, Block 23, Smithson Subdivision, as recorded in Plat Book 78, Page 45, in the office of the County Recorder.

   • Investment Portfolio: Account Number XXXXXXXXX at [Investment Firm], consisting of stocks, bonds, and mutual funds.

Affidavit Statement:

I affirm that at least 60 days have elapsed since the death of the decedent, no application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction, and I am lawfully entitled to collect the property described herein.

Oath:

I swear/affirm under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.

Subscribed and sworn to (or affirmed) before me on this [DAY] of [MONTH], [YEAR], by [YOUR NAME], proved to me on the basis of satisfactory evidence to be the person who appeared before me.

Signature:

[YOUR NAME]

Subscribed and sworn to (or affirmed) before me on this ___ day of [Month], [Year], by [Your Full Name], proved to me on the basis of satisfactory evidence to be the person who appeared before me.

[Notary Name]

[Date]

Affidavit Templates @ Template.net