29A-6-432. Optional form of affidavit of confirmation. The following form or a document that contains substantially all of the following information may be used to create the affidavit of confirmation:

AFFIDAVIT OF CONFIRMATION AND SURVIVORSHIP FOR TRANSFER ON DEATH

DEED State of South DakotaCounty of _________________I, ________________________, being first duly sworn on oath, state 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 property in ______________ County, South Dakota, legally described as follows: ___________________________________ and Decedent was the transferor in a transfer on death deed (Deed) recorded on _____________, as in Book ______ of _____, Page _____, in the office of the register of deeds of ______________ County, South Dakota.

3. The name(s) and address(es) of the Designated Beneficiary(ies) named in the Deed who survived the Decedent is(are):

_________________________________________________________

_________________________________________________________

_________________________________________________________

4. The name(s) and address(es) of the contingent beneficiary or person who takes under the anti-lapse statutes and who survived the Decedent.

_________________________________________________________

_________________________________________________________

5. The Designated Beneficiary(ies) named in the Deed who did not survive the Decedent is(are):

_________________________________________________________

_________________________________________________________Certified copies of Certificate(s) of Death for any deceased Designated Beneficiary(ies) is(are) also attached hereto.

6. Notice of the death of the Decedent has been given to the South Dakota Department of Social Services and it has been determined that no assistance was provided or that any obligation for reimbursement to the department has been satisfied.

Affiant

Notary

Source: SL 2014, ch 133, § 32.