Affidavit Of Identity And Survivorship For Transfer {50.2.3}

(Top 3 inches reserved for recording data) AFFIDAVIT OF IDENTITY AND SURVIVORSHIP FOR TRANSFER ON DEATH DEED Minn. Stat. 507.071 State of Minnesota, County of Minnesota Uniform Conveyancing Blanks Form 50.2.3 (2011) ("Affiant"), being first duly sworn on oath, states that to my personal knowledge: 1. ("Decedent") is the person named in the certified copy of the Certificate of Death attached hereto. 2. On the date of death, Decedent was an owner of the real property in County, Minnesota, legally described as follows: Check here if all or part of the described real property is Registered (Torrens) and Decedent was the Grantor Owner in a transfer on death deed ("Deed") recorded on , as Document Number (month/day/year) (or in Book in the Office of the of County Recorder Registrar of Titles of (check the applicable box) Page ), County, Minnesota. (If recorded with the Registrar of Titles, insert the Certificate of Title number .) v3 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 v3 Minnesota Uniform Conveyancing Blanks Form 50.2.3 3. The Grantee Beneficiary(ies) named in the Deed who survived the Decedent by 120 hours is(are): (insert names of the Grantee Beneficiary(ies) who survived the Decedent, and if none, insert "NONE") . 4. The Grantee Beneficiary(ies) named in the Deed who did not survive the Decedent by 120 hours is(are): . (insert names of the Grantee Beneficiary(ies) who did not survive the Decedent, and if none, insert "NONE") Certified copies of Certificate(s) of Death for any deceased Grantee Beneficiary(ies) is(are) also attached hereto. 5. A Clearance Certificate pursuant to Minn. Stat. 507.071 subd. 23 attached to this affidavit. Affiant is or is not (check only one box) (signature) Signed and sworn to before me on (month/day/year) , by . (insert name of Affiant) (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED IN THIS INSTRUMENT SHOULD BE SENT TO: (insert legal name and residential or business address) American LegalNet, Inc. www.FormsWorkFlow.com