Fill and Sign the Indiana Summary Administration Package under 50000 Personal Property Small Estates Form

State of Indiana County of _____________________________ In The _____________________________ Court IN THE MATTER OF THE ESTATE OF : ) ) _____________________________ ) Deceased ) ) ) Case No. _ __________________ SMALL ESTATE AFFIDAVIT SUMMARY ADMINISTRATION (Estate Containing Real Property - IC 29-1-8-3(b)) State of Indiana County 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 the personal representative acti ng on behalf of the distributees of the above estate, and I make this affidavit as required by IC 29-1-8-3(b). 4. The estate of the above named decedent includes the following real property: (1) In the County of _____________________________ , real property described as: (legal description) 5. It appears that the decedent’s gross probate estate, less liens and encumbrances, does not exceed the sum of the following: fifty thousand dollars ($50,000.00), the costs and expenses of administration, and reasonable funeral expenses. 6. Forty-five (45) 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. The individuals entitled to a part interest in the above real property as a result of the decedent’s death, the share to which they are entitled, and whether that share is divided or undivided are as follows: Name: Share: Divided/Undivided: 1. _______________________ _______________________ _______________________ 2. _______________________ _______________________ _______________________ 3. _______________________ _______________________ _______________________ 4. _______________________ _______________________ _______________________ Each individual’s share was determined as follows: 1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 9. I have notified each person identified above of my intention to present this affidavit and a m entitled to payment or delivery of the property on behalf of each person identified in this affidavit. THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY. ________________________________________ Signature of Affiant STATE OF ________________________ COUNTY OF ______________________ Before me, _______________________________, (title of officer) this ________ day of ______, ________________________, 20 ____ acknowledged the execution of the annexed __________________________ (name of instrument). ___________________________________ Notary Public, State of _________________ Printed Name: ________________________ Commission Expires: ______________________