Fill and Sign the Assignment Order Form

Assignment For valuable consideration, I, ______________________________ (Name of Assignor) , of ___________________________________________________________________________ __________________________ (street address, city, county, state, zip code) , hereinafter called Assignor , hereby assign to _____________________________________ (Name of Assignee) , of ______________________________________________________________________________ ___________________ (street address, city, county, state, zip code) , hereinafter called Assignee , a specific legacy of $________________ bequeathed to me under the will of ________________ _______________________ (Name of D ecedent) . This Assignment is executed to secure a debt of $_________________ owing to Assignee by Assignor . Any money or property received under this Assignment shall be used by Assignee first to extinguish all of the indebtedness then owing by Assignor to Assignee, and the remainder of any such money or property, if any, will be paid to Assignor by Assignee . At the request of Assignee , I shall execute any additional documents necessary to effectuate this Assignment. This Assignment shall be governed by, construed, and enforced in accordance with the laws of _____________________________ (Name of State) . Witness my signature this ____________________________ (date) . _______________________________ ___________________________________ (Printed Name and Signature of Assignor) Acknowledgment 1 STATE OF _______________________ COUNTY OF ________________________ Personally appeared before me, the undersigned authority in and for said County and State, on this _____________________________ (date) , within my jurisdiction, the within- named ___________________________________ ( Name of Assignor) , who acknowledged that he/she executed the above and foregoing instrument. ___________________________ NOTARY PUBLIC My Commission Expires: ______________________ 1 Form of Acknowledgment may vary by state.