Fill and Sign the Utah Small Form

Affidavit for Collecting Personal Property in a Small Estate Proceeding Being first duly sworn, I state that: (1) This affidavit is made for the purpose of collecting the personal property of ____________________________________________________ (name) , who died on ___________________ (date) , as authorized by Utah Code Section 75-3-1201; (2) (a) [ ] I am the decedent’s successor and entitled to payment or delivery of the property; (b) [ ] I am the duly authorized agent of ____________________________________________________ (name) , who is the decedent’s successor; (3) The value of the entire estate subject to administration, wherever located, less liens and encumbrances, does not exceed $100,000; (4) 30 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’s successor is entitled to payment or delivery of any indebtedness owed to the decedent, any tangible personal property belonging to the decedent, and any instruments evidencing a debt, obligation, stock, or chose in action belonging to the decedent; and (7) Such indebtedness, tangible personal property or instrument evidencing a debt, obligation, stock, or chose in action include: Sign here ► Date Typed or Printed Name On this date, I certify that _________________________________________________________ (name) who is known to me or who presented satisfactory identification, in the form of ______________________________________________________ (form of identification) , has, while in my presence and while under oath or affirmation, voluntarily signed this document and declared that it is true. Sign here ► Date Typed or printed name (Notary Public) Notary Seal Small Estate Affidavit – Personal Property February 2009 Revised May 9, 2017 Page 1 of 1