Fill and Sign the Affidavit Before Me a Notary Public in and for Said County Form

STATE OF ALABAMA AFFIDAVIT FOR DISPOSITION OFSMALL BANK ACCOUNT OF DECEDENT COUNTY OF___________ Before me, the undersigned Notary Public, in and for the County and State aforesaid, personally appeared _______________________________, who having been by me first duly sworn, depose and say as follows: _____________________________________ died on _______________________, being then a resident of ____________ County, Alabama. At the time of his/her death, he/she left no surviving spouse. There have been no Letters Testamentary nor Letters of Administration issued nor a Personal Representative appointed by any court, nor is there any proceeding now pending in any court which would have jurisdiction over the administration of this estate or the probate of this will. We do not plan to have the will probated. At this point, the persons who are entitled to inherit a share of the personal property of the deceased are _________________________________________________________________________________________________________________________________________. This Affidavit is given pursuant to Code of Alabama § 5-5A-38, and given to _______________________________________ Bank in consideration of its releasing a bank deposit which is in the name of ____________ and in an amount of less than $5,000.00. The undersigned hereby certifies that ___________________________________________________________ is/are the proper person to receive the deposits from the _____________________ account. _________________________________ (SEAL) STATE OF ALABAMA COUNTY OF _____________ I, the undersigned authority, a Notary Public in and for said County, in said State, do hereby certify that ____________________, whose name is signed to the foregoing affidavit and who is known to me, acknowledged before me on this day, that being informed of the contents of the affidavit, he/she executed the same voluntarily on the day the same bears date.Given under my hand and official seal, this _____ day of ___________ ______. _____________________________________ (SEAL)Notary Public