Fill and Sign the Small Estate Affidavit for Estates Not More Than 75000 Minnesota Form

AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY FOR SMALL ESTATES PURSUANT TO MINN. STAT. § 524.3-1201 STATE OF MINNESOTA COUNTY OF _______________________ Affiant _______________________ , being first duly sworn, deposes and states: 1. Affiant resides at _______________________ . 2. _______________________ died at the age of _________ on _______________________ , 20 _________ ; and at the time of his death resided at: _______________________ , City of _______________________ , County of _______________________ , State of _______________________ , having a Social Security Number _______________________ ; 3. Affiant as the _______________________ is the successor of the above identified decedent and is entitled to _________ % (per cent) of any property owed the decedent; 4. The value of the entire probate estate, wherever located, less liens and encumbrances does not exceed $50,000.00; 5. Thirty (30) days have elapsed since the death of the decedent; 6. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction; 7. Affiant, the claiming successor, is entitled to payment of delivery of the following described property, to wit: _______________________ 8. Affiant, the claiming successor, agrees to disburse the proceeds collected under this affidavit to any person with a superior claim under Minn. Stat. §§ 524.2-403 or 524.3-805. 9. Attached hereto is the certified death certificate. FURTHER AFFIANT SAYETH NOT. Select a method of payment: Please send payments by direct deposit to employee’s account. 1 Please send payments by warrant (check). Dated: _______________________ _______________________________________ Affiant _______________________ Affiant’s Social Security Number The foregoing instrument was acknowledged before me this _____ day of ______________, 20____ by ____________________________________. ____________________________________ (Signature of Notary Public or other Official) My Commission Expires: ________________ 2