Form 420es - Affidavit For Collection Of Personal Property Pursuant To Small Estate Proceeding
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2STATE OF SOUTH CAROLINA
)
IN THE PROBATE COURT
)
COUNTY OF: _____________________________
)
)
AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY
)
PURSUANT TO SMALL ESTATE PROCEEDING
IN THE MATTER OF:
)
_________________________________________
)
CASE NUMBER: ____________________________________
(Decedent)
)
The undersigned states as follows:
Decedent’s Information:
1.
Full Legal Name
(include all known names):
Date of Birth:
Date of Death:
Age at date of Death:
2.
Decedent was domiciled in this county at date of death:
Address: __________________________________________________________________________________________
County: ______________________________________ State: South Carolina.
Decedent was not domiciled in South Carolina, but probate property of Decedent was located in this county at date
of death at:
Address: __________________________________________________________________________________________
County: ______________________________________ State: South Carolina.
If the above address is the address of a nursing home, prison, or other residential facility, please give the last address of
the Decedent prior to entering the facility: ________________________________________________________________
__________________________________________________________________________________________________
3. More than thirty (30) days have passed since the Decedent’s death.
4. No Application or Petition for the appointment of a Personal Representative is pending or has been granted in any
jurisdiction.
5. This affidavit is pursuant to SCPC 62-3-1201. The successor(s) named herein is/are entitled to the payment of any sums of
money due and owing to the Decedent, and to the delivery of all probate tangible personal property belonging to the
Decedent and in the possession of another, and to the delivery of all instruments evidencing a debt, obligation, stock, or
chose in action belonging to the Decedent in the following proportions. Names and addresses of the Decedent’s successors
(Example: heirs or devisees) are:
Name of Successor*
Address
Year of
Relationship
Percentage
Birth
Interest/
Amount
See attached sheets for additional successors (check if applicable)
(*For this purpose, successors include any person(s) who has/have paid reasonable funeral expenses;
attach proof of payment.)
Form #420ES (04/2017)
Page 1 of 2
62-3-1201, 62-3-1202
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