Affidavit of Death - Template, Sample Form to Complete Pro · US-law

SMALL ESTATE AFFIDAVIT

FOR COLLECTION AND DISTRIBUTION OF DECEDENT'S PERSONAL PROPERTY

State of ________

County of ________

§ 1. Affiant. I, ________, residing at ________, being of the age of eighteen (18) years or older and of sound mind, and being first duly sworn upon oath, do hereby depose and state as follows for the purpose of collecting, receiving, and distributing the personal property of the decedent identified below pursuant to the small estate procedures of the laws of the State of ________.

§ 2. Decedent. This Affidavit concerns the estate of ________ (the “Decedent”), whose Social Security Number ended in ________, who was a resident of the State of ________, residing at ________ at the time of death, and who died on ________ in ________. The fact and date of death are evidenced by a certified copy of the Decedent's Certificate of Death, a true and correct copy of which is attached hereto and incorporated herein by reference.

§ 3. Statutory Waiting Period. Not less than ________ days, as required by the applicable laws of the State of ________, have elapsed since the date of the Decedent's death prior to the making of this Affidavit.

§ 4. No Personal Representative. No application or petition for the appointment of a personal representative, executor, or administrator of the Decedent's estate is pending or has been granted in any jurisdiction; and no probate proceeding has been commenced with respect to the Decedent's estate.

§ 5. Value of the Estate. The fair market value of the entire estate of the Decedent subject to administration, wherever located, less liens and encumbrances, does not exceed the statutory maximum permitted for collection of personal property by affidavit under the laws of the State of ________, and is estimated to be $________ (________ dollars).

§ 6. Entitlement of Affiant. The Affiant is the successor of the Decedent and is entitled to payment, delivery, and distribution of the property described in § 8 below by reason of the following relationship and authority: ________. No other person has a right to the interest of the Decedent in the described property that is superior to that of the Affiant.

§ 7. Debts and Expenses. All debts of the Decedent, including funeral and burial expenses, expenses of last illness, taxes, and all unsecured debts, have been paid in full or otherwise adequately provided for.

§ 8. Property Claimed. The Affiant hereby claims, and demands the payment, delivery, transfer, and assignment of, the following property belonging to the Decedent, held by the persons or institutions identified below:

________

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu.

§ 11. Distribution. The Affiant shall apply and distribute the property collected pursuant to this Affidavit in accordance with the rights of the Decedent's successors as established by the applicable laws of the State of ________.

§ 12. Oath or Affirmation of Affiant:

I declare and certify under penalty of perjury under the laws of the State of ________ that I have read the foregoing Affidavit, that I know the contents thereof, and that the statements made herein are true and correct to the best of my knowledge, information, and belief.

______________________________
________, Affiant

______________________________
Date

ACKNOWLEDGMENT

STATE OF ________, COUNTY OF ________:

On this ________ day of ________, ________, before me, ________, a Notary Public in and for said State and County, personally appeared ________, known to me (or satisfactorily proven on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.

IN WITNESS WHEREOF, I hereunto set my hand and official seal.

______________________________
Notary Public

________
Title

My commission expires: ________