Fill and Sign the Small Estate Affidavit 497429174 Form

SMALL ESTATE AFFIDAVIT State of Washington County of       I,       , upon duly sworn, state on my oath that: 1. My post office address is:       2. My residence address is:       3. I am a successor to the decedent identified below as defined in RCW 11.62.005. All successors, including myself, of the decedent are listed as follows: Name/Relationship Address                                                 4. The decedent's name is       . 5. The date of the decedent's death was       , and I have attached a copy of the death certificate hereto. Note: At any time after forty days from the date of a decedent's death, any person who is indebted to or who has possession of any personal property belonging to the decedent or to the decedent and his or her surviving spouse as a community, which debt or personal property is an asset which is subject to probate, shall pay such indebtedness or deliver such personal property, or so much of either as is claimed, to a person claiming to be a successor of the decedent upon receipt of proof of death and of an affidavit made by said person. 6. That the value of the decedent's entire estate subject to probate, not including the surviving spouse's community property interest in any assets which are subject to probate in the decedent's estate, wherever located, less liens and encumbrances, does not exceed one hundred thousand dollars. 7. That forty days have elapsed since the death of the decedent. 8. That no application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 9. That all debts of the decedent including funeral and burial expenses have been paid or provided for. 10. A description of the personal property and the portion thereof claimed, together with a statement that such - 1 - personal property is subject to probate is as follows:             11. That the claiming successor has given written notice, either by personal service or by mail, identifying his or her claim, and describing the property claimed, to all other successors of the decedent, and that at least ten days have elapsed since the service or mailing of such notice. 12. That the claiming successor is either personally entitled to full payment or delivery of the property claimed or is entitled to full payment or delivery thereof on the behalf and with the written authority of all other successors who have an interest therein. THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY.* ________________________________________ Signature of Affiant SWORN TO AND SUBSCRIBED BEFORE ME ON THIS THE       DAY OF       , 20       . ____________________________________________ NOTARY PUBLIC My commission expires: ___________________________ - 2 - Notes: 1. A transfer agent of any security shall change the registered ownership of the security claimed from the decedent to the person claiming to be the successor with respect to such security upon the presentation of proof of death and of an affidavit made by such person which meets the requirements of subsection (2) of this section. Any governmental agency required to issue certificates of ownership or of license registration to personal property shall issue a new certificate of ownership or of license registration to a person claiming to be a successor of the decedent upon receipt of proof of death and of an affidavit made by such person which meets the requirements of subsection (2) of this section. 2. No release from any Washington state or local taxing authority may be required before any assets or debts are paid or delivered to a successor of a decedent as required under this section. 3. A copy of the affidavit, including the decedent's social security number, shall be mailed to the state of Washington, department of social and health services, office of financial recovery. - 3 -