Shareholder Resources

Affidavit for Determination of Right to Receive A.N.C.S.A. Stock

Filed by an heir or personal representative when an Emmonak shareholder passes away without a valid stock will, or when a will exists and must be confirmed against the ANCSA succession rules. Executed under AS 13.16.705(a) with reference to 43 U.S.C. §§ 1606(h) and 1607(c). Complete this wizard to generate a draft — you must still print, sign, and either notarize, have a U.S. Postmaster acknowledge, or (subject to counsel confirmation) submit digitally as an AS 09.63.020 unsworn declaration before mailing the signed original to Shareholder Records with a certified death certificate.

Privacy notice

This form asks for sensitive personal information, including Social Security numbers, dates of birth, place of birth and blood quantum. It is sent over a secure, encrypted connection to records@emmonak.com for processing this request. If you would prefer not to enter this information online, download the PDF version and mail the signed original to Emmonak Corporation, P.O. Box 49, Emmonak, AK 99581.

FORM EMK-AFF-01 · REV A · 2026-07

Filed under AS 13.16.705(a) with reference to 43 U.S.C. §§ 1606(h) and 1607(c). This affidavit determines who inherits Emmonak Corporation stock from a deceased shareholder when there is no valid stock will, or when a will exists and must be confirmed against the succession rules.

ANCSA spousal-share formula (AS 13.12.102(b)): the surviving spouse receives 100% of the ANCSA stock if there are no surviving descendants, or 50% if there are surviving descendants (children or grandchildren representing predeceased children).

Section B — Affiant Information

Your full legal name *

Your mailing address *

Phone

Email *

Section C — Deceased Shareholder

Deceased shareholder's full legal name *

Former names / maiden name (if any)

Social Security number🔒 SENSITIVE

Date of birth *🔒 SENSITIVE

Place of birth🔒 SENSITIVE

Date of death *

Place of death

Emmonak (village) enrollment number🔒 SENSITIVE

Calista (regional) enrollment number🔒 SENSITIVE

Any other ANC enrollment (name of corporation + enrollment number)

Blood quantum (optional — retained for Emmonak records; not a legal gate on inheritance)🔒 SENSITIVE

Section D — Will / Stock Will Status

Does a will or stock will exist for the deceased? *

No will or stock will exists

Unknown whether a will exists

Testamentary clause on the back of a stock certificate

Separate stock-will form (Emmonak or Calista)

General last will and testament

Other testamentary instrument (describe below)

Section E — Marital Status & Spouse

Section F — Children of the Deceased

Did the deceased have any children (natural-born, adopted-in, or adopted-out)? *

Yes

Section H — Siblings of the Deceased (shown when there is no surviving spouse, no children, and no surviving parent)

Section I — Prior Lifetime Transfers

Was any of the deceased's ANCSA stock previously transferred during life? *

No prior lifetime transfers

By court decree (divorce or child support), 43 U.S.C. § 1606(h)(1)(C)(i)

Professional-restriction transfer under 43 U.S.C. § 1606(h)(1)(C)(ii)

Inter vivos gift under 43 U.S.C. § 1606(h)(1)(C)(iii)

Multiple of the above

Section J — Supporting Documents

I have attached (or agree to mail with the signed original) a certified copy of the death certificate. *

Do any adoption decrees, court orders, or paternity determinations apply? *

Yes

Not applicable

Section K — Execution Method

How will you execute this affidavit? *

Print, sign, and have notarized by an Alaska notary public (traditional path)

Print, sign, and have acknowledged by a U.S. Postmaster (permitted for rural shareholders)

Submit digitally under AS 09.63.020 unsworn declaration under penalty of perjury (subject to counsel confirmation before final acceptance)

Required Acknowledgements

I certify the information in this affidavit is true to the best of my knowledge and belief. *

I understand this affidavit is submitted under penalty of perjury under Alaska law (AS 09.72.010; AS 09.63.020 for the unsworn declaration path). *

I understand this affidavit governs ANCSA settlement common stock only and that ANCSA stock is not subject to general probate under AS 13.16.705(a). *

I understand this submission is a DRAFT for the corporation's records; the affidavit is not legally effective for stock transfer until the signed original (with the death certificate and any supporting documents) is received and recorded by Emmonak Corporation. *

I understand a certified death certificate is required before Emmonak Corporation can accept this affidavit under its AS 13.16.685 good-faith review. *

Form EMK-AFF-01 · Rev A · 2026-07 · Filed under AS 13.16.705(a) with reference to 43 U.S.C. §§ 1606(h), 1607(c). Emmonak Corporation, P.O. Box 49, Emmonak, AK 99581.