W. Va. Code § 44-1-4
§44-1-4. Appointment of intestate administrator; affidavit of heirs of nonresident intestate decedent without appointment of intestate administrator.
(b) Notwithstanding the provisions of subsection (a) of this section:
(1) Any person having an interest in real estate situate in this state that was seized and possessed by a decedent who was a nonresident of this state and who has died interstate without any will, including a personal representative who has qualified in another state or jurisdiction, for which no appointment of an ancillary personal representative or administrator to administer the real estate within this state is necessary for any proper purpose may execute and tender for recording in the county an affidavit setting forth in substance:
(c) A document substantially in the following form may be used as the affidavit provided in subsection (b) of this section with the effect as prescribed in this section:
THE COUNTY COMMISSION OF ______________ COUNTY, WEST VIRGINIA
IN RE: THE ESTATE OF _________________________
DOD: ________________________
AFFIDAVIT FOR ANCILLARY ADMINISTRATION
OF WEST VIRGINIA REAL ESTATE
WITHOUT APPOINTMENT
(INTERSTATE)
STATE OF _________________,
COUNTY OF ________________, to-wit"
I,__________________________________, whose address is ___________________
_____________________________________________________________________________, being first duly sworn, upon oath and under penalty of perjury, do depose and say as follows:
1. The decedent,_____________________________, died on
__________________________(date of death), a resident of____________________ County, State of
_________________________. The decedent has left no will so far as I know, and no will of the decedent has been presented or probated in this state or in any other state or jurisdiction.
2. More than 60 days have passed since the death of the decedent's estate has been otherwise appointed in the State of West Virginia for any proper purpose.
3. A certified death certificate has been furnished herewith for filing in this County.
4. The Decedent died owning and possessing the following real estate situate in West Virginia:
| Description | County | Assessed Value | Fair Market value | |
| a. | ||||
| b. | ||||
| c. | ||||
| d. | ||||
| Total |
5. the decedent, _____________________, left as his/her heirs at law in accordance with the laws of interstate descent and distribution of the State of West Virginia the following persons:
a. Name:____________________________________________________________
Address:_________________________________________________________
Relationship to Decedent:________________________________________
Share or percentage:_____________
b. Name:____________________________________________________________
Address:_________________________________________________________
Relationship to Decedent:________________________________________
Share or percentage:_____________
c. Name:____________________________________________________________
Address:_________________________________________________________
Relationship to Decedent:________________________________________
Share or percentage:_____________
d. Name:____________________________________________________________
Address:_________________________________________________________
Relationship to Decedent:________________________________________
Share or percentage:_____________
6. No appointment of an ancillary personal representative to administer the decedent's real estate within the State of West Virginia is necessary for any proper purpose.
7. I have personal knowledge of the above facts and am interested in the Estate of
_______________________, the decedent, as the ( ) acting domiciliary personal representative, ( ) surviving spouse, ( ) beneficiary under the decedent's will, ( ) heir at law, or ( ) other
____________________________ (describe relationship or interest.) [Check one]
_________________________________
Signature of Affiant
Taken, subscribed, and sworn to before me the undersigned authority by
________________________________________, this _________ day of ____________________, 20_____.
{seal}
My Commission expires: _______________________________
_________________________________________________________
Notary Public