Fill and Sign the Small Estate Maine Form

1 SMALL ESTATE AFFIDAVIT Collection of Personal Property State of Maine 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 a successor to the decedent, _________________________, through my relationship as _________________________. 4. The decedent's name is _________________________ and the decedent resided at _________________________. 5. The date of the decedent's death was the ______ day of _________________________, 20______. 6. That the value of the entire estate of the decedent subject to administration, wherev er located, less liens and encumbrances, does not exceed twenty thousand dollars ($ 20,000.00). 7. That at least thirty (30) 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. I am entitled to payment or delivery of the property hereby claimed. THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY. ________________________________________ Signature of Affiant 2 Acknowledgment of Individual STATE OF MAINE COUNTY OF _________________ The foregoing instrument was acknowledged before me this __________________________ (date) by ___________________________________ (name of person acknowledged). _________________________________ Notary Public Print Name: ______________________ My Commission Expires: _____________________