Fill and Sign the Summary Administration Package under 50000 Personal Property Small Estates Indiana Form

State of Indiana County of _____________________________ In The _____________________________ Court IN THE MATTER OF THE ESTATE OF : ) ) _____________________________ ) Deceased ) ) ) Case No. ___________________ SMALL ESTATE AFFIDAVIT SUMMARY ADMINISTRATION (Estate Containing Real Property - IC 29-1-8-3(b)) State of Indiana 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 the personal representative acting on behalf of the distributees of the above estate, and I make this affidavit as required by IC 29-1-8-3(b). 4. The estate of the above named decedent includes the following real property: (1) In the County of _____________________________ , real property described as: (legal description) 5. It appears that the decedent’s gross probate estate, less liens and encumbrances, does not exceed the sum of the following: fifty thousand dollars ($50,000.00), the costs and expenses of administration, and reasonable funeral expenses. 6. Forty-five (45) days have elapsed since the death of the decedent. 7. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 8. The individuals entitled to a part interest in the above real property as a result of the decedent’s death, the share to which they are entitled, and whether that share is divided or undivided are as follows: Name: Share: Divided/Undivided: 1. _______________________ _______________________ _______________________ 2. _______________________ _______________________ _______________________ 3. _______________________ _______________________ _______________________ 4. _______________________ _______________________ _______________________ Each individual’s share was determined as follows: 1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 9. I have notified each person identified above of my intention to present this affidavit and am entitled to payment or delivery of the property on behalf of each person identified in this affidavit. THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY. ________________________________________ Signature of Affiant STATE OF ________________________ COUNTY OF ______________________ Before me, _______________________________, (title of officer) this ________ day of ______, ________________________, 20 ____ acknowledged the execution of the annexed __________________________ (name of instrument). ___________________________________ Notary Public, State of _________________ Printed Name: ________________________ Commission Expires: ______________________