Small Estate Affidavit: Collection Of Personal Property Form printable pdf download

Small Estate Affidavit: Collection Of Personal Property Form

SMALL ESTATE AFFIDAVIT

Collection of Personal Property

State of Nebraska

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 legal successor to the decedent, ______________________________________,

who resided at ____________________________________________________________.

4. I am entitled to be named as a successor to the decedent due to my relationship to the

decedent, or I have a claim to the personal property of the decedent, namely:

________________________________________________________________________.

5. The decedent passed from this life on the _____ day of ________________, 20____.

6. The value of all of the personal property in the decedent's estate, wherever located, less

liens and encumbrances, does not exceed fifty thousand dollars ($5 0 ,000).

7. At least thirty (30) days have elapsed since the death of the decedent as shown in the attached

certified or authenticated copy of the decedent's death certificate .

8. 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

State of Nebraska

County of _______________________

Subscribed and sworn to before me on this the _____ day of _________________, 20____.

____________________________________

Notary Public, State of Nebraska

Printed Name: _______________________

My Commission Expires: _________________

Disclaimer

This form is provided without any warranty, express or implied, as to its legal effect and

completeness. Please use at your own risk. If you have a serious legal problem, we suggest that

you consult an attorney.

Small Estate Affidavit: Collection Of Personal Property Form