WARNING: To protect against the possibility of others accessing your confidential 
                                                    information, do not complete these forms on a public workstation. 

                                     Affidavit of Successor

The “Affidavit of Successor” may be used if the decedent’s estate was not probated and no personal representative 
has been appointed by the courts. Living heirs have certain rights according to Washington State laws of Descent 
and Distribution. One heir may claim and distribute to other heirs with their written approval.  Please note this     
affidavit is only to be used for personal property.  The transfer of real estate or real property is not allowed.
The undersigned, being first duly sworn, on oath deposes and says:
1.That the name and address of the undersigned successor is as follows:
             a. Decedent Name:
                Successor Name:
             b. Address:
             c. City:                                  State:                 Zip:
2. The undersigned claimant is a “successor” as defined in Revised Code of Washington (RCW) 11.62.005.
    (One box MUST be checked or the form will be rejected)
       Under the terms and provisions of the decedent’s last will and testament or
       Under the laws of intestate succession and/or
       As the surviving spouse or domestic partner entitled to property under the community property laws.
3. The undersigned does not claim to be a successor solely by reason of being a creditor of the decedent or of
    the decedents’s estate.
4. The decedent was, at the time of their death, a resident of the state of Washington.
5. The value of the entire estate of the decedent subject to probate, wherever located, (not including any
    surviving spouse’s community property interest in any assets which are subject to probate in the decedent’s
    estate), less liens and encumbrances, does not exceed $100,000.
6. Forty days have elapsed since the death of the decedent.
7. No application or petition for the appointment of a personal representative is pending or has been granted
    in any jurisdiction.
8. All debts of the decedent including funeral and burial expenses have been paid or provided for.
9. The undersigned successor claims the following personal property, which property is subject to probate:
                      Description of Property                                 Amount

10. The undersigned successor has given written notice, either by personal service or by mail, identifying his
    or her claim, and describing the property claimed, to all other successors of the decedent, and that at least
    ten days have elapsed since the service or mail of such notice.
11. The undersigned successor is:  (One box MUST be checked and the back of this form (page 2) must
    be completed or the form will be rejected)
                Personally entitled to full payment or delivery of the property described above as the sole heir or, 
                Notarized written authority and copy of ID from all heirs is included authorizing the claimant to receive 
                full payment or,
                An heir entitled to a portion of the property described above and claiming only that portion.

I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

Claimant Signature                                     Date 

Subscribed and sworn (or affirmed) to before me this                    day of                    ,                   .

               Notary Public (print name)                               Notory Public (signature) 

                      Residing at                                       Commission Expires
REV 80 0029 (6/24/19)

Deceased Name:

What is the relationship to the deceased:
    Spouse (date of marriage              )           Parent                                               Niece/Nephew
 Child                                                Granddaughter/son                                    Other

Did the deceased leave a will?
    Yes 
    No 

1.  If the decedent left a will, was it probated?
        Yes - Do not use this form, send the following items:
             1. Copy of the probabted will
             2. Addresses for all heirs listed in the will
        No - Complete this form and send a copy of the will. 

2.  Was the deceased married when they passed away?
        Yes, spouse’s name 
             Are they living?  
                     Yes
                     No - If no, provide date of death
        No 

3.  How many children did the deceased have?  List the names of the children (if deceased, include date of death)

4.  Are the parents of the deceased living?
        Yes - If yes, provide their names 

 No 

5. How many brothers and sisters did the deceased have?  List their full names (if deceased, include date of death)

                                                                                                                       Print This Form

If you are claiming as a remote relative, you must provide a complete family tree showing your relationship to the deceased.  
The family tree should include names and dates of death for all relatives of the deceased.
For tax assistance or to request this document in an alternate format, visit http://ucp.dor.wa.gov or call 360-534-1502. Teletype (TTY) users may use the 
Washington Relay Service by calling 711.
REV 80 0029 (6/24/19)
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