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CORRECTIVE AFFIDAVIT (Form CA26)

CAPITAL ACQUISITIONS TAX CONSOLIDATION ACT, 2003 (to be used where the deceased died on or after 5th December, 2001)

Courts Service

Please complete this form in BLOCK CAPITALS using BLUE INK When completed, this form in duplicate and all other relevant documentation (i.e. Original Grant of Representation, Administration Bond (if necessary) should

be submitted to the Probate Office/District Probate Registry. All consideration to be stated in whole Euro only and do not enter cent.

All fields are mandatory

Details of the Person/Solicitor to be contacted in the event of Enquiry regarding this Affidavit

Forename Surname Address

Telephone No.

Contact e-mail Agent's Reference

Information relating to the deceased

PPS No. of Deceased Forename of deceased Surname of deceased

Address

DX Number (if applicable)

TAIN

-

DD

MM

YYYY

Date of Death

/

/

Place of issue of Grant

Details of the applicants I/We, the Applicant(s)

Forename of 1st Applicant Surname of 1st Applicant Address

Occupation Relationship to deceased

CA26

DD

MM

YYYY

Date of Grant

/

/

Page 1

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Details of the applicants

Forename of 2nd Applicant Surname of 2nd Applicant

Address

Occupation

Relationship to deceased

Forename of 3rd Applicant Surname of 3rd Applicant Address

Occupation

Relationship to deceased

Sworn declaration

I/We make oath and say as follows;-

1. It appears that the Inland Revenue Affidavit already delivered in this deceased's estate requires correction as shown

herein. 2. The contents of this Affidavit are true and correct to the best of my/our knowledge, information and belief, and this

Affidavit has been completed in accordance with the provisions of the Capital Acquisitions Tax Consolidation Act, 2003.

SWORN by Surname of 1st Applicant

Signature of Applicant/Deponent

Forename of 1st Applicant

At

On the

day of

Before me, a Commissioner for Oaths/Practising Solicitor/Court Clerk

and (Tick relevant box and Delete as appropriate) (i) the Deponent (Applicant) is personally known to me

or

(ii) the Deponent (Applicant) has been identified to me by who is personally known to me

Identifier's Signature I certify that I know the Deponent/Applicant

or (iii) the identity of the Deponent has been established by reference to a relevant document containing a photograph

Document Type:

Issue No:

Signature Commissioner for Oaths/Practising Solicitor/Court Clerk

WARNING: IF THE APPLICANT(S) SWEAR TO THIS AFFIDAVIT WITHOUT PERSONALLY VERIFYING THAT THE STATEMENTS IN IT ARE TRUE, THEY MAY MAKE THEMSELVES LIABLE TO PENALTIES.

CA26

Page 2

5858115452

Sworn declaration (cont.)

Surname of 2nd Applicant

Signature of Applicant/Deponent

Forename of 2nd Applicant

At

On the

day of

Before me, a Commissioner for Oaths/Practising Solicitor/Court Clerk

and (Tick relevant box and Delete as appropriate) (i) the Deponent (Applicant) is personally known to me or

(ii) the Deponent (Applicant) has been identified to me by who is personally known to me

Identifier's Signature I certify that I know the Deponent/Applicant

or (iii) the identity of the Deponent has been established by reference to a relevant document containing a photograph

Document Type:

Issue No:

Signature Commissioner for Oaths/Practising Solicitor/Court Clerk

Surname of 3rd Applicant Forename of 3rd Applicant

Signature of Applicant/Deponent

At

On the

day of

Before me, a Commissioner for Oaths/Practising Solicitor/Court Clerk

and (Tick relevant box and Delete as appropriate) (i) the Deponent (Applicant) is personally known to me or

(ii) the Deponent (Applicant) has been identified to me by who is personally known to me

Identifier's Signature I certify that I know the Deponent/Applicant

or (iii) the identity of the Deponent has been established by reference to a relevant document containing a photograph

Document Type:

Issue No:

Signature Commissioner for Oaths/Practising Solicitor/Court Clerk

WARNING: IF THE APPLICANT(S) SWEAR TO THIS AFFIDAVIT WITHOUT PERSONALLY VERIFYING THAT THE STATEMENTS IN IT ARE TRUE, THEY MAY MAKE THEMSELVES LIABLE TO PENALTIES.

CA26

Page 3

4005115455

All considerations to be stated in whole EURO only. Do not enter Cent

N.B. Items not needing correction should not be inserted. PERSONAL PROPERTY AND REAL PROPERTY SITUATE IN THE STATE Items of property in the Inland Revenue Affidavit or the last Corrective Affidavit, needing correction, and omitted property and deductions (if any).

Description of Assets Value as last previously

shown

Millions

Thousands Hundreds

,

,

,

,

Increase/Decrease

Millions

Thousands Hundreds

,

,

,

,

Value as now corrected

Millions

Thousands Hundreds

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

Description of Debts

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

,

SUMMARY OF INCREASE/DECREASE IN VALUE OF IRISH ESTATE

Gross Irish Estate

Value as last previously shown

,

,

Increase/Decrease

,

,

Irish Debts

,

,

,

,

Net Irish Estate

,

,

,

,

Value as now corrected

,

,

,

,

,

,

PERSONAL PROPERTY AND REAL PROPERTY OUTSIDE THE STATE

Items of property in the Inland Revenue Affidavit or the last Corrective Affidavit, needing correction, and omitted property and deduction (if any).

Description of Assets Value as last previously shown

Increase/Decrease

Value as now corrected

,

,

,

,

,

,

,

,

,

,

,

,

Description of Debts

,

,

,

,

,

,

CERTIFICATE OF PROBATE REGISTRAR

,

,

Fees on additional assets paid and further security given

Signature

DD

MM

YY YY

//

CA26

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Registrar 8827115451

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