[ name of applicant ] _______________ # ___
[ date affidavit is sworn ] _________________
Form 75 (Rule 64 (2) ) S.C. No._________
ESTATE OF ______________, Deceased
AFFIDAVIT OF ADMINISTRATOR
(Will Annexed)
I, [ name, address and occupation of applicant ], ______________________
_________________________________ MAKE OATH (OR SOLEMNLY
AFFIRM) AND SAY THAT:
1. __________________________, late of [ street address and city ] __________
__________________________ in Yukon, [ occupation ] ___________________ died on the _____ day of _______________, 20__, at _________________ in
Yukon. Attached as Exhibit ____ is a copy of the Certificate of Death.
2. T he deceased’s original last will dated the _____ day of ___________, _____ is attached as Exhibit ____ [ include codicils as separate exhibits if necessary ] .
3. There is no executor named in the will [ or, set out the reason no person is presently entitled and willing to act as executor of the will, e.g., executor named has predeceased, renounced, etc.
].
4. My relationship to the deceased is ______________________ and [ identify the applicant’s entitlement to the grant, e.g., one of the residuary beneficiaries, etc .] ___________________________________________________________.
The renunciation or consent of all persons having a prior or equal right to apply for the grant or entitled to share in the estate are filed, as follows: ___________.
5. To the best of my knowledge the deceased did/did not marry or remarry after the date of the will.
6. To the best of my knowledge the will is/is not witnessed by a person or their then spouse to whom, a beneficial devise, bequest or other disposition or appointment is given or made.
7. I have made a diligent search and inquiry to ascertain the assets and liabilities of the deceased.

8. The Statement of Assets, Liabilities and Distribution attached as Exhibit ____ discloses the assets and liabilities of the deceased, irrespective of their nature, location or value, which pass to the deceased’s personal representative, together with the names and addresses of the beneficiaries, their relationship to the deceased and the property passing to them.
9. I will promptly disclose to the court the existence of any asset or liability which has not been disclosed in Exhibit ____ when I learn of it.
10. I will administer according to law all the estate which by law devolves to and vests in me, in the personal representative of the deceased, and I will provide a true and perfect inventory of the estate and render a just and true account thereof whenever required by law to do so.
SWORN (OR AFFIRMED) before me at ___________________ , in
_____________________ on this
___ day of ____________, 20 __
__________________________ ____________________
A Notary Public in and for the Applicant
Yukon Territory

ESTATE OF ______________, Deceased
STATEMENT OF ASSETS, LIABILITIES AND DISTRIBUTION
Part I and vendors and purchasers interests in agreements for sale)
REAL PROPERTY (including mortgages Within or Without
Yukon
Value at Death
Total Real Property
Part II
PERSONAL PROPERTY (all assets except real property)
Within or Without
Yukon
$
Value at Death
Total Personal Property
SAFETY DEPOSIT BOX No. and
Location
$
$ TOTAL GROSS VALUE OF ESTATE
Part III
DEBTS AND LIABILITIES
Total Debts and Liabilities
TOTAL NET VALUE OF ESTATE
Part IV
DISTRIBUTION OF ESTATE
Paid or Unpaid
$
$
Name Relationship
This is Exhibit ____ referred to in the affidavit of __________________ made before me at __________________ this ____ day of
________________, 20__.
____________________________________
A Notary Public in and for the Yukon Territory
Property Passing