Fill and Sign the Beneficiary Estate Form

IN THE _____________ (Name) COURT OF _____________ (Name of County) , _______________ (Name of State) IN THE MATTER OF THE ESTATE OF ______________________, DECEASED NO. _____________ (Name of Decedent) Sworn Statement of Beneficiary of Estate and Consent to Close Estate STATE OF ____________________ COUNTY OF _______________________ PERSONALLY appeared before me, the undersigned authority in and for said county and state, ________________ (Name of Affiant) , who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. I acknowledge receipt from __________________ (name of personal representative) , the personal representative of the Estate of ____________________ (name of decedent) , of the property set forth in the Schedule I attached to this instrument. 2. I accept the property in full payment and satisfaction of my interest in the Estate. 3. I accept the property subject to possible liability in the nature of (description of potential liability) ____________________________________________________________ ___________________________________________________________________________. 4. I acknowledge receipt of a full, written accounting of the personal representative's administration of the Estate, and approve such accounting. 5. I release the personal representative and the estate from all liability in connection with my interest in the estate. 6. I consent to the informal closing of the estate by sworn statement filed by the personal representative pursuant to ____________________________ (citation of statute) . ___________________________________ (Printed Name of Affiant) ___________________________________ (Signature of Affiant) SWORN to and subscribed before me, this the ____ day of ______________, 20_____. _____________________________ NOTARY PUBLIC My Commission Expires: ___________________