IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

ORPHANS’ COURT DIVISION

AFFIDAVIT OF RELATIONSHIP TO DECEDENT

In re: Estate of
Deceased	Date of Death

COMMONWEALTH OF PENNSYLVANIA	)

: ss:

COUNTY OF LEHIGH	)

, being duly sworn according to law, deposes and says:

I am adult individual who can read, write and understand the English language.

died intestate, a resident of Lehigh County, Pennsylvania, and no personal representative has been appointed.

died testate, a resident of Lehigh County, Pennsylvania, his/her will has not been offered for probate and no personal representative has been appointed.

I am the surviving spouse of , having been married to him/her on , pursuant to Marriage License No. issued by ;

The decedent was not survived by a spouse;

I am the adult child of ; the other adult children of are:

Name
Address (if dec’d provide date of death)

I am the parent of ; the other parent of is ,:

Name
Address (if dec’d provide date of death)

I am the adult sibling of ; the other adult siblings of are:

Name
Address (if dec’d provide date of death)

and further states that the above facts are true and correct.

BY:
Date:
Signature

Print Name	Address:

SWORN to and subscribed before

me this___________________ day of

_____________________, 20_____.

_____________________________

Notary Public

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IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

Woffindin_jt

2019-01-03

Rachel A Wotring