Affidavit Request

Print, Complete and Mail this Request Form

(You may print this page using the printer icon button at the bottom

of this page or by using the printer option on your computer)

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Affidavit as to Death of Owner

Request Form

Deceased Owner's Name as set forth in original

General Warranty Deed or Quit Claim Deed

(send copy of such deed)

________________________________________________________________________________

Date of Death of Owner (send copy of death certificate)

________________________________________________________________________________

Relationship of Deceased Owner to Surviving Owner

________________________________________________________________________________

Missouri County where the Real Property is located

_______________________________________________________________________________

Address of Real Property

______________________________________________________________________________

Your Full Name

_____________________________________________________________________________

Your Relationship to Surviving Owner _________________

Your Mailing Address

___________________________________________________________________________

Your Telephone Number

___________________________________________________________________________

Your Signature*

___________________________________________________________________________

Surviving Owner's Mailing Address

___________________________________________________________________________

Surviving Owner's Telephone Number

___________________________________________________________________________

Signature of Surviving Owner*

___________________________________________________________________________

*(by signing this form you acknowledge and agree to the Important Notes below)

.

IMPORTANT NOTES*

1. By signing this form you agree this form will serve as the written agreement between yourself and Michael J. Denk, Attorney at Law and Missouri Beneficiary Deed, LLC, to draft and provide you with one (1) Affidavit as to Death of Owner (at the cost of $145) per your request and based upon the information you provide on this form. You understand and agree no other drafting services are being provided to you.

2. The signing and proper recording of your Affidavit and the fee charged by the local County Recorder of Deeds office to record such Affidavit will be and is your responsibility.

3. You understand and agree no legal advice is being provided to you and you should consult with an Attorney of your choice for such legal advice.

4. On your behalf and on behalf of your estate you hereby release and hold harmless Michael J. Denk, Attorney at Law and Missouri Beneficiary Deed, LLC, from any and all claims relating to your use and implementation of such Affidavit.

_______________________________________________________________________

Print, Complete and Mail this Request Form

(You may print this page by using the printer icon button at the bottom

of this page or by using the printer option on your computer)

~

Affidavit as to Death of Grantor

Request Form

Grantor's Name as set forth in Beneficary Deed

(send copy of such Beneficiary Deed)

__________________________________________________________________________________

Date of Death of Grantor (send copy of death certificate)

__________________________________________________________________________________

Name(s) of Grantee(s)/Beneficiary(ies) as set

forth in Beneficiary Deed

_____________________________________________________________________________

Name and Mailing Address of one Grantee

(no P.O. Boxes)

____________________________________________________________________________

Missouri County where Real Property is located

____________________________________________________________________________

Missouri City where Real Property is located

___________________________________________________________________________

Address of Real Property

__________________________________________________________________________

Your Full Name

__________________________________________________________________________

Your Relationship to the Grantor _____________________

Your Mailing Address

___________________________________________________________________________

Your Telephone Number

___________________________________________________________________________

Your Signature*

___________________________________________________________________________

*(by signing this form you acknowledge and agree to the Important Notes below)

IMPORTANT NOTES*

1. By signing this form you agree this form will serve as the written agreement between yourself and Michael J. Denk, Attorney at Law and Missouri Beneficiary Deed, LLC, to draft and provide you with one (1) Affidavit as to Death of Grantor (at the cost of $145) per your request and based upon the information you provide on this form. You understand and agree no other drafting services are being provided to you.

2. The signing and proper recording of your Affidavit and the fee charged by the local County Recorder of Deeds office to record such Affidavit will be and is your responsibility.

3. You understand and agree no legal advice is being provided to you and you should consult with an Attorney of your choice for such legal advice.

4. On your behalf and on behalf of your estate you hereby release and hold harmless Michael J. Denk, Attorney at Law and Missouri Beneficiary Deed, LLC, from any and all claims relating to your use and implementation of such Affidavit.