Fill and Sign the In the Superior Court for the State of Alaska at Juneau Form

P-110 JUNEAU web (2/07) (page 1 of 2) PF 1 AFFIDAVIT FOR COLLECTION OF PERSONAL AS 13.16.680 PROPERTY OF DECEDENT IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT JUNEAU In the Matter of the Estate of: ) ) ) AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY OF DECEDENT I, , being duly sworn, state the following: 1. I am the successor of who died on , 20 . I am the successor by reason of the fact that . (state basis upon which you claim to be successor) 2. The value of the entire estate of the decedent, wherever located, less liens and encumbrances, does not exceed $15,000. 3. Thirty days have elapsed since the death of the decedent. 4. No application or petition for the appoint ment of a personal representative of the decedent’s estate is pending or has been granted in any jurisdiction. 5. I, as successor of the decedent, am entitled to the payment of any sums \ of money due and owing the decedent and to the delivery of all tangible personal property belonging to the decedent and to the delivery of all instruments evidencing a debt, obligation, stock or chose in action belonging to the decedent. Signature Mailing Address City State ZIP Telephone Subscribed and sworn to or affirmed before me at , Alaska on . (date) Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: It is so ordered this day of , 20 . Judge Type or Print Judge’s Name P-110 JUNEAU web (2/07)(page 2 of 2) Probate Form 91 AFFIDAVIT FOR COLLECTION OF PERSONAL AS 13.16.680 PROPERTY OF DECEDENT Alaska Statutes Sec. 13.16.680. Collection of personal property by affidavit. (a) Thirty days after the death of a decedent, any person indebted to the decedent or having possession of tangible personal property or an instrument evidencing a debt, obligation, stock, or chose in action belonging to the decedent shall make payment of the indebtedness or deliver the tangible personal property or an instrument evidencing a debt, obligation, stock, or chose in action to a person claiming to be the successor of the decedent upon being presented an affidavit made by or on behalf of the successor stating that (1) the value of the entire estate, wherever located, less liens and encumbrances, does not exceed $15,000; (2) 30 days have elapsed since the death of the decedent; (3) no application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction; and (4) the claiming successor is entitled to payment or delivery of the property. (b) A transfer agent of any security shall change the registered ownership on the books of a corporation from the decedent to the successor or successors upon the presentation of an affidavit as provided in (a) of this section. (§ 1 ch 78 SLA 1972; am § 4 ch 80 SLA 1984) Sec. 13.16.685. Effect of affidavit. The person paying, delivering, transferring, or issuing personal property or the evidence of it under affidavit is discharged and released to the same extent as if the person dealt with a personal representative of the decedent. The person is not required to see to the application of the personal property or evidence of it or to inquire into the truth of any statement in the affidavit. If any person to whom an affidavit is delivered refu ses to pay, deliver, transfer, or issue any personal property or evidence of it, it may be recovered or its payment, delivery, transfer, or issuance compelled upon proof of their right in a proceeding brought for the purpose by or on behalf of the persons entitled to it. Any person to whom payment, delivery, transfer, or issuance is made is answerable and accountable for it to any personal representative of the estate or to any other person having a superior right. (§ 1 ch 78 SLA 1972) Sec. 13.06.050. General definitions (48) "successor" means a person, other than a creditor, who is entitled to property of a decedent under the decedent's will or AS 13.06 - AS 13.36;