THE COUNTY COMMISSION OF __________ COUNTY, WEST VIRGINIA
IN RE: THE ESTATE OF ______________________
DOD: _____________________
AFFIDAVIT FOR ANCILLARY ADMINISTRATION
OF WEST VIRGINIA REAL ESTATE
WITHOUT APPOINTMENT
(INTESTATE)
STATE OF ________________ ,
COUNTY OF ______________ , to-wit:
I, ______________________________ , whose address is __________________ _________________________________________________________________ , being first duly sworn, upon oath and under penalty of perjury, do depose and say as follows:
Description | County | Assessed Value | Fair Market value | |
a. | ||||
b. | ||||
c. | ||||
d. | ||||
Total |
Address: __________________________________________________
Relationship to Decedent: ____________________________________
Share or percentage: __________
Address: __________________________________________________
Relationship to Decedent: ____________________________________
Share or percentage: __________
Address: __________________________________________________
Relationship to Decedent: ____________________________________
Share or percentage: __________
Address: __________________________________________________
Relationship to Decedent: ____________________________________
Share or percentage: __________
( ) surviving spouse, ( ) beneficiary under the decedent's will, ( ) heir at law, or ( ) other ______________________________ (describe relationship or interest). [Check one]
______________________________
Signature of Affiant
Taken, subscribed, and sworn to before me the undersigned authority by
_________________________________ , this day of , 20___.
{seal}
My Commission expires: ______________________________
__________________________________________________
Notary Public
W. Va. Code § 44-1-4