Poa-20 - Distributee'S Affidavit Form For Disposition Of Estates - 2009
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1State of Indiana
)
) SS:
County of _________________ )
POA-20
distributee’s affidavit
sf# 49377
for disposition of estates, pursuant to i.c. 29-1-8-1
(R2 / 6-09)
_________________________________________, and _________________________________________
after having been first duly sworn according to law say:
1. That ___________________________________________________ departed this life (testate) (intestate)
(Circle one)
on the _____ day of ____________________, ________, a resident of the State of _________________.
Year
2. That said decedent left no widow or widower surviving him or her and that your affiants are all of the persons
who are entitled to the real and personal property of said decedent (under his or her will) (under the statutes
of intestate succession of the State of __________________).
(Circle one)
3. That the value of the entire assets of the estate of said decedent does not exceed the sum of $50,000.00.
4. That no petition for the appointment of a personal representative for the estate of said decedent is pending
or has been granted.
5. That 45 days have elapsed since the death of the said decedent.
6. That there is in the possession of the Auditor of the State of Indiana, property of the said decedent de-
scribed
as follows:
Warrant No. ________________ in the amount of $ ___________.
Warrant No. ________________ in the amount of $ ___________.
7. That your affiants request the Auditor of State of Indiana to endorse the above listed warrant to:
____________________________________________________________________________________
for the benefit of your affiants as distributees of the estate of said decedent.
And further affiants say not.
____________________________________________________
____________________________________________________
(Signature)
Subscribed and sworn to before me, a Notary Public, this _________ day of ________________, ________.
Year
____________________________________________
(Signature)
Notary Public
(Printed) _____________________________________
My Commission expires: _____________________________.
Resident of __________________________________County.
Mail completed form to: State Auditor’s Office, State House, Rm. 234B, Indianapolis, IN 46204.
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