Fill and Sign the Checklist for Filing Affidavit for Succession to Real Form

1 of 2 02/04/00 afftranspp.wpd AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY STATE OF ARIZONA ) ) ss. COUNTY OF ) , being duly sworn, on oath deposes and sa ys: died on , in the County of , State of , more than thirty da ys prior to e xecution of this Aff idav it. Check either 1(a) or 1(b): 1. (a) Affiant is the successor of the decedent, entitled to decedent’s property by W ill or intestate succession and the value of all of the personal property in the decedent’s estate, wherever located, less liens and encumbrances, does not exceed FiftyThousand Dollars ($50,000). (b) Affia nt is cla iming a s the surviving spouse dep end ent c hild of decedent and th e va lu e of a ll personal proper ty i n t h e deceden t’ s es ta te , wherever located, l e ss liens and encu mbrances, does not e x ceed th e grea ter of e ither F if ty Thousand Dollars ($50,000) or the total sums permitted as the allowance in lieu of homestead, e x em pt p rop erty , and the f a mily a llow an ce , pu rsu ant to A rizona Revised Statutes, i n effect on th e da te of th e deceden t’ s dea th. Check either 2(a) or 2(b): 2. (a) No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. (b) A personal representative has been appointed and EITHER has been discharged OR more than one year has elapsed since a closing statement was filed AND , as of the date of this Affidavit, Fifty Thousand Dollars ($50,000) has not been exceeded. 2 of 2 02/04/00 afftranspp.wpd 3. Decedent owned the following personal property: 4. The affiant is entitled to receive payment of any debt due the decedent and to receive decedent’s tangible personal property or an instrument evidencing the transfer to affiant of any debt, obligation, stock or chose in action belonging to decedent. This Affidavit is made pursuant to A.R.S. §14-3971, as amended, for the purpose of making claim to property of the decedent under said statute. Date Affiant’s Signature Affiant’s Printed Name SUBSCRIBED AND SWORN TO before me on . My Commission Expires: Notary Public