Form 420es - Affidavit For Collection Of Personal Property Pursuant To Small Estate Proceeding Page 2
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26. The value of the entire probate estate wherever located, less liens and encumbrances, does not exceed Twenty-Five
Thousand Dollars ($25,000.00) and does not include any interest in real property as indicated below:
Bank account
$
Bank Name:
Type of Account:
Stock
$
Company Name:
# of shares:
Unclaimed Property
$
From:
Motor Vehicle :
$
VIN:
YR/MAKE:
MODEL:
Mobile Home:
$
VIN:
YR/MAKE:
MODEL:
Boat/Motor/Trailer:
$
VIN:
YR/MAKE:
MODEL:
Life Insurance to estate:
$
Company Name:
Other Property (specify):
$
LIENS/ENCUMBRANCES against above assets (attach proof of encumbrance): $ _________________________________
See attached sheet for additional assets/ encumbrances (check if applicable)
VERIFICATION
The undersigned, being sworn, states:
That the facts set forth in the foregoing statements are true to the best of the
undersigned's knowledge, information and belief; and the undersigned hereby submits to the Court's jurisdiction in this matter.
SWORN to before me this
day of
Affiant Signature:
, 20
Print Name:
Address:
Notary Public for South Carolina
Telephone (Work):
My Commission Expires:
(Home):
(Cell):
E-mail:
Relationship to Decedent/Estate:
ORDER FOR PAYMENT OR DELIVERY
It appears from the foregoing affidavit, the original of which is on file with the Probate Court of this county, that payment or
delivery of the property described herein should be made as follows:
Name of Successor(s)
Address
Relationship
Percentage
Interest/
Amount
Upon issuance of this Order, this matter is hereby closed.
IT IS SO ORDERED this _______ day of ___________________________, 20_________.
, Probate Court Judge
Note: No person who may act in reliance on this affidavit shall incur any liability to the estate of the Decedent.
Form #420ES (04/2017)
Page 2 of 2
62-3-1201, 62-3-1202
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