Fill and Sign the Notethe Second Option Should Be Checked Only in Cases Where the Decedent Had No Outstanding Debts or the Personal Form

File No. Name Of Decedent AFFIDAVIT OF NOTICE TO CREDITORS G.S. 28A-14-1, 28A-14-2 NOTE: The second option should be checked only in cases where the decedent had\ no outstanding debts, or the personal representative has paid in full all known debts. The first option should be checked in all other cases. The undersigned affiant, being first duly sworn, says that: 1. Pursuant to G.S. 28A-14-1, I made a reasonable effort to ascertain all persons, firms and corporations (including the Department of Health and Human Services, Division of Medical Assistance, if at the \ time of the decedent’s death the decedent was receiving Medicaid) having unsatisfied claims against the decedent and personally delivered or mailed a copy of the Notice to Creditors to all such persons, firms and corporations then known to me, except for those claims that I recognize as valid. 2. No copy of the Notice to Creditors required by G.S. 28A-14-1 was mailed or personally delivered because, after making a reasonable effort within the time provided by law, I am satisfied that there are no persons, firms or corporations (including the Department of Health and Human Services, Division of Medical Assistance,\ if at the time of the decedent’s death the decedent was receiving Medicaid) having unsatisfied claims against the decedent. (See note above.) NOTE: Signature of only one affiant is necessary. IN THE MATTER OF THE ESTATE OF: STATE OF NORTH CAROLINA County In The General Court Of Justice Superior Court Division Before The Clerk Personal Representative Or Collector Attorney For Personal Representative Or Collector Personal Representative Or Collector Attorney For Personal Representative Or Collector Date Signature Of Affiant Signature Of Co-Affiant Date Date My Commission Expires Date My Commission Expires County Where Notarized County Where Notarized Date Date Signature Signature Notary Notary Deputy CSC Deputy CSC Assistant CSC Assistant CSC Clerk Of Superior Court Clerk Of Superior Court SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL SEAL AOC-E-307, Rev. 2/15