Fill and Sign the Iowa Small Estate Affidavit Form

AFFIDAVIT I, __________________, being duly sworn according to law on oath, under penalty of perjury, depose and say: 1. I reside at:Street Address/P.O. Box __________________ City: __________________ County: ____________ State: __________________ 2. I am the spouse or the child other successor of the decedent, __________________, SSN __________________, who departed this life on or about the ______ day of ____________, ______. The decedent's place of residence immediately before death was ____________. The decedent died (a) without leaving a will or (b) leaving a will dated the ______ day of ____________, 20______. That the attached copy of the decedent's will is the last will of the decedent and has been delivered to the office of a clerk of the district court in accordance with Iowa law. 3. That the gross value of the decedent's personal property that would otherwise be distributed by will or intestate succession is or has been at any time since the decedent's death, twenty-five thousand dollars or less and there is no real property or the real property passes to persons exempt from inheritance tax as joint tenants with full rights of survivorship. 4. That at least forty days have elapsed since the death of the decedent, as shown by an attached certified copy of the death certificate of the decedent. 5. The successors to the decedent’s estate include the following Successor’s Name: _____________________________ Social security tax identification number: _____________________________ Relationship to the decedent _____________________________ Under a legal disability: Yes: No General description of the property of the decedent that is to be paid, transferred, or delivered to or for the benefit of the successor: _____________________________ Successor’s Name: _____________________________ Social security tax identification number: _____________________________ Relationship to the decedent _____________________________ Under a legal disability: Yes: No General description of the property of the decedent that is to be paid, transferred, or delivered to or for the benefit of the successor: _____________________________ Successor’s Name: _____________________________ Social security tax identification number: _____________________________ Relationship to the decedent _____________________________ Under a legal disability: Yes: No General description of the property of the decedent that is to be paid, transferred, or delivered to or for the benefit of the successor: _____________________________ Successor’s Name: _____________________________ Social security tax identification number: _____________________________ Relationship to the decedent _____________________________ Under a legal disability: Yes: No General description of the property of the decedent that is to be paid, transferred, or delivered to or for the benefit of the successor: _____________________________ Successor’s Name: _____________________________ Social security tax identification number: _____________________________ Relationship to the decedent _____________________________ Under a legal disability: Yes: No General description of the property of the decedent that is to be paid, transferred, or delivered to or for the benefit of the successor: _____________________________ Successor’s Name: _____________________________ Social security tax identification number: _____________________________ Relationship to the decedent _____________________________ Under a legal disability: Yes: No General description of the property of the decedent that is to be paid, transferred, or delivered to or for the benefit of the successor: _____________________________ Successor’s Name: _____________________________ Social security tax identification number: _____________________________ Relationship to the decedent _____________________________ Under a legal disability: Yes: No General description of the property of the decedent that is to be paid, transferred, or delivered to or for the benefit of the successor: _____________________________ 6. That no persons other than those the successors listed in the affidavit have a right to the interest of the decedent in the described property. 7. I request that the described property be paid, delivered, or transferred to or for the benefit of each successor. Further affiant say naught. Affiant Print Name STATE OF IOWA COUNTY OF Date: On the above date, before me, a Notary Public, personally appeared: __________________ to me known to be the person named in and who executed the foregoing instrument, and subscribed, swore, and acknowledged before me that he/she/they executed the same as his/her/their voluntary act and deed. Notary Public Print Name (Seal, if any) My commission expires: