Fill and Sign the South Dakota Small Estate Heirship Affidavit for Estates under 50000 Form

1 SMALL ESTATE AFFIDAVITCollection of Personal Property South Dakota State of South Dakota County of ______________ I, ____________________________________________________________________, upon being duly sworn, state on my oath that: 1. My post office address is: ___________________________________________________ 2. My residence address is: ___________________________________________________ 3. The value of the entire estate, wherever located, less liens and encumbrances, does not exceed $50,000; 4. Thirty days have elapsed since the death of the decedent; 5. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 6. The decedent has not incurred any indebtedness to the Department of Social Services for medical assistance for nursing home or other medical institutional care; 7. A copy of the affidavit will be furnished to the Department of Revenue and any inheritance tax due will be paid; and 8. The claiming successor is entitled to payment or delivery of the property. 9. The decedent's name is ____________________________________________________ and the decedent resided at ________________________________________________. 10. 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 SOUTH DAKOTA COUNTY OF _________________On this ____ day of _________________, in the year __________, before me personally appeared ______________________________________, known to me (or proved to me on the oath of ______________________________) to be the person who is described in, and who executed the within instrument and acknowledged to me that ______________ he/she/they executed the same. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________