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    Affidavit of Surviving Spouse or NOK

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    kirk enage
    This document is an affidavit for the surviving spouse or next of kin of a deceased U.S. citizen living abroad. It requests information to help consular officers fulfill their duties to serve as a provisional conservator of the deceased's personal effects and determine who is legally entitled to the estate. The affidavit asks the claimant to provide their name and address, details of the deceased such as address and date of death, and their relationship to the deceased. It also requests information on other surviving relatives and is signed under oath with a notary witness.

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    © All Rights Reserved
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    Affidavit of Surviving Spouse or NOK

    Uploaded by

    kirk enage
    390 views3 pages
    This document is an affidavit for the surviving spouse or next of kin of a deceased U.S. citizen living abroad. It requests information to help consular officers fulfill their duties to serve as a provisional conservator of the deceased's personal effects and determine who is legally entitled to the estate. The affidavit asks the claimant to provide their name and address, details of the deceased such as address and date of death, and their relationship to the deceased. It also requests information on other surviving relatives and is signed under oath with a notary witness.

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    This document is an affidavit for the surviving spouse or next of kin of a deceased U.S. citizen living abroad. It requests information to help consular officers fulfill their duties to serve as a provisional conservator of the deceased's personal effects and determine who is legally entitled to the estate. The affidavit asks the claimant to provide their name and address, details of the deceased such as address and date of death, and their relationship to the deceased. It also requests information on other surviving relatives and is signed under oath with a notary witness.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    390 views3 pages

    Affidavit of Surviving Spouse or NOK

    Uploaded by

    kirk enage
    This document is an affidavit for the surviving spouse or next of kin of a deceased U.S. citizen living abroad. It requests information to help consular officers fulfill their duties to serve as a provisional conservator of the deceased's personal effects and determine who is legally entitled to the estate. The affidavit asks the claimant to provide their name and address, details of the deceased such as address and date of death, and their relationship to the deceased. It also requests information on other surviving relatives and is signed under oath with a notary witness.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    U. S.

    Department of State
    CONSULAR OFFICES OF THE UNITED STATES OF AMERICA
    AFFIDAVIT FOR THE SURVIVING SPOUSE OR NEXT OF KIN
    *Provide information below to the extent that it is available.

    VENUE

    State

    ss.

    City

    I, being duly sworn according to law, declare that I reside at


    Your Name
    and that on
    Street Address (Including City, State/or Country) Date of Death (mm-dd-yyyy)
    had permanent legal residence at
    Name of Deceased
    . I am the
    Complete Address of the Deceased Specify: widow, widower, child, father,
    mother, sibling, other

    and as such am entitled to receive the decedent's estate under the laws of . To the best of my knowledge,
    Name of state/foreign state in the
    United States or foreign country
    where the deceased last had a
    permanent legal residence

    did/did not have a will or trust specifying the disposition of his or her estate.
    Name of Deceased

    NAME(S) OF SURVIVORS, IN ORDER OF KINSHIP

    Please insert the name of living relatives in the following order of relationship: surviving spouse, children, father and/or mother, brothers and/or
    sisters, other:

    Date of Birth
    Name (mm-dd-yyyy) Address Telephone Number Relationship

    DS-5511 Page 1 of 3
    10-2008
    Name Date of Birth Address Telephone Number Relationship

    Subscribed and sworn to before me by


    Signature of Affiant

    Type Name of Affiant Date (mm-dd-yyyy)

    Address of Notary Public

    Signature of Notary Public Type Name of Notary Public

    DS-5511 Page 2 of 3
    PRIVACY ACT STATEMENT

    The information on this form is requested to assist U.S. Consular Officers to fulfill the
    requirements of 22 U.S.C. 2715c and determine the next-of-kin of an American citizen who
    dies abroad. A U.S. Consular Officer, or a U.S. diplomatic Officer is required to serve as
    "provisional conservator" of the personal effects of U.S. citizens who die abroad at the time
    of their death if there is not a legal representative, partner in trade, or trustee appointed to
    take care of the decedent's estate and if the responsibilities of a "provisional conservator"
    are authorized by treaty by the authorities or usage of the country where the death occurs
    or the decedent is domiciled. Additionally, in exceptional circumstances, a U.S. Consular
    Officer may also serve as administrator of an estate. A U.S. Consular officer may only
    release the personal effects of the decedent to a person who has qualified legally to take
    care of the decedent's estate or, in appropriate circumstances, to the next of kin.

    Providing the information in the affidavit is voluntary, but, failure to complete this form will
    require the person claiming to be next-of-kin to obtain and present alternative documents
    such as certified copies of Letters Testamentary, Letters of Administration, or trust
    documents.

    ROUTINE USES: The information solicited on this form may be made available to federal,
    state, local, or foreign government entities for administrative or law enforcement purpose,
    including for the notification of kin or judicial matters involving contested estates and
    related issues.

    DS-5511 Page 3 of 3

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