3. If the death certificate is silent as to the decedent's marital status at the time of his or her death, the payor is not liable for making a payment on account of, or for transferring an interest in, that portion of the asset to the primary beneficiary upon delivery to the payor of an affidavit validly executed by the primary beneficiary in substantially the following form:
STATE OF ____________
COUNTY OF ____________
Before me, the undersigned authority, personally appeared (type or print Affiant's name) ("Affiant"), who swore or affirmed that:
1.
(Type or print name of Decedent) ("Decedent") died on
(type or print the date of the Decedent's death) .
2. Affiant is a "primary beneficiary" as that term is defined in Section 732.703, Florida Statutes. Affiant and Decedent were married on
(type or print the date of marriage) , and were legally married to one another on the date of the Decedent's death.
(Affiant)
Sworn to or affirmed before me by the affiant who is personally known to me or who has produced (state type of identification) as identification this ____ day of (month) ,...(year)....
(Signature of Officer)
(Print, Type, or Stamp Commissioned name of Notary Public)
4. If the death certificate is silent as to the decedent's marital status at the time of his or her death, the payor is not liable for making a payment on account of, or for transferring an interest in, that portion of the asset to the secondary beneficiary upon delivery to the payor of an affidavit validly executed by the secondary beneficiary affidavit in substantially the following form:
STATE OF ____________
COUNTY OF ____________
Before me, the undersigned authority, personally appeared (type or print Affiant's name) ("Affiant"), who swore or affirmed that:
1.
(Type or print name of Decedent) ("Decedent") died on
(type or print the date of the Decedent's death) .
2. Affiant is a "secondary beneficiary" as that term is defined in Section 732.703, Florida Statutes. On the date of the Decedent's death, the Decedent was not legally married to the spouse designated as the "primary beneficiary" as that term is defined in Section 732.703, Florida Statutes.
Sworn to or affirmed before me by the affiant who is personally known to me or who has produced (state type of identification) as identification this ____ day of (month) , (year) .
(Signature of Officer)
(Print, Type, or Stamp Commissioned name of Notary Public)