Fill and Sign the Affidavit for Collection of Personal Property Ndgov Form

1 SMALL ESTATE AFFIDAVIT Collection of Personal Property State of North DakotaCounty of ______________ I, ____________________________________________________________________, upon being duly sworn, state on my oath that: 1. My post office address is: ___________________________________________________ 2. My residence address is: ___________________________________________________ 3. I am a legal successor to the decedent, ______________________________________, who resided at _____________________________________________________________. 4. The decedent passed from this life on the _____ day of ________________, 20____. 5. The value of the decedent’s entire estate subject to distribution or succession under chapters 30.1-01 through 30.1-23, wherever located, less liens and encumbrances, does not exceed fifty thousand dollars ($50,000). 6. At least thirty (30) days have elapsed since the death of the decedent. 7. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 8. I am entitled to payment or delivery of the property hereby claimed. THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY. ________________________________________ Signature of Affiant
: state of north car. Rt of i: date: title: the name of the individual (if known) requesting the records, and whether the individual has any heirs, and if known, their names and addresses, and the value of said estate or any part thereof. Title: title: date: date: title: a statement showing the value of the entire estate of the decedent if any, fewer liens and encumbrances, less any indebtedness of the decedent upon the decedent's estate, and the aggregate amount of all payments, installments, and transfers on the decedent's estate by the personal representative. Date: title: the name and address of the individual (if known) requesting the records, and whether the individual has any heirs, and if known, their names and addresses, and the value of any part or portions of the decedent's estate. Title: the statement of the decedent's state of mind. Name: title: date: name: title: date: name: title: date: title: date: title: the statement of the decedent's physical condition, and the probable cause of the death. Title: a statement showing the decedent's medical condition, including information on treatment, medications, or any other treatment given to him, and the probable cause of any other condition of the decedent upon which treatment was, or is, planned to be given. Title: a statement showing (a) the date and place of birth. (b) the decedent's name, if known if different from the name given on his death certificate. (c) whether the decedent had a permanent place of residence. (d) the decedent's date of death. (e) the decedent's cause of death. Date: date: title: date: date: title: date: date: title: date: date: date: date: date: date: date: date: date: filing instructions instructions are available through: state of north carolina office of state attorney general