NSW UCPR Form 1 - Title s1

Sample Affidavit that Deceased was not in a Defacto Relationship (Form 126)

This is a sample. It is important that your completed form is based on your own circumstances and the estate you are dealing with. If you need more help you should get legal advice.

Form 126 (version 2)

Part 78 rule 20(2) and rule 22(2)

SCR Form 98A/99

AFFIDAVIT THAT DECEASED WAS NOT IN A DEFACTO RELATIONSHIP

COURT DETAILS
Court / Supreme Court of New South Wales
Division / Equity
List / Probate
Registry / Sydney
Case number / 20XX/1234567890
TITLE OF PROCEEDINGS
The estate of Stewart Grimson
Late of: Redfern, NSW

FILING DETAILS

Filed for / Arya Grimson, plaintiff
Contact name and telephone / Arya Grimson (02) 9100 XXXX
Contact email /
AFFIDAVIT
Name / Arya Grimson
Address / 2 Example Street, Redfern NSW 2016
Occupation / Hairdresser
Date / 6 September 20XX

I affirm:

1. I am the daughter of the deceased.

2. I lived with the deceased up to the time of his death and for a continuous period of 25 years.

3. The deceased’s de facto partner, Shelly Allbright, died on 10 May 20XX. Annexed and marked “A” is a certificate of death for Shelly Allbright. Prior to her death, the deceased had been in a de facto relationship with Shelly Allbright for a continuous period of 28 years.

4. The deceased did not leave any person who at the time of his death was his de facto partner, for whom the estate or any part of it is required to be held under a statutory trust for the partner.

5. I am aware of the provisions of section 21C of the Interpretations Act 1987.

Leyla Green

Arya Grimson

AFFIRMED at Redfern
Signature of deponent / Arya Grimson
Name of witness / Leyla Green
Address of witness / Suite 10/105 Example Street, Redfern NSW 2016
Capacity of witness / Justice of the peace
And as a witness, I certify the following matters concerning the person who made this affidavit (thedeponent):
1. I saw the face of the deponent.
2. I have confirmed the deponent’s identity using the following identification document:
Driver’s licence No. 2xxxxxxx
Identification document relied on (may be original or certified copy)2
Signature of witness / Leyla Green

1 [The only "special justification" for not removing a face covering is a legitimate medical reason (at April 2012).]

2 ["Identification documents" include current driver licence, proof of age card, Medicare card, credit card, Centrelink pension card, Veterans Affairs entitlement card, student identity card, citizenship certificate, birth certificate, passport or see Oaths Regulation 2011 or JP Ruling 003 - Confirming identity for NSW statutory declarations and affidavits, footnote 3.]