AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY FOR SMALL ESTATES
PURSUANT TO MINNESOTA STATUTES §524.3-1201
STATE OF MINNESOTA, COUNTY OF
, being first duly sworn, deposes and states:
Affiant resides at
died at the age of
and at the time of death, resided at
, County of
, State of
having a Social Security Number
and Employee ID
Affiant, as the
, is the successor of the above identified decedent
and is entitled to
percent of any property owed the decedent;
The value of the entire probate estate, wherever located, less liens and encumbrances, does not exceed $50,000.00;
Thirty (30) days have elapsed since the death of the decedent;
No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction;
Affiant, the claiming successor, is entitled to payment of delivery of the following property, to wit:
Affiant, the claiming successor, agrees to disburse the proceeds collected under this affidavit to any person with a superior claim
under Minnesota Statutes §524.2-403 or §524.3-805.
Attached hereto is the certified death certificate.
FURTHER AFFIANT SAYETH NOT.
Select a method of payment:
Please send payments by direct deposit to employee’s account
Please send payments by warrant (check).
:____________________ ________________________________ ____________________________
Affiant's Social Security Number
Subscribed and sworn to before me this
__________ day of _______________________, _____________
Notary Public, _________________________ County, Minnesota
My commission expires _________________________________
NOTICE: Name, Home Address, and Social Security number are private data that will be available only to those individuals who need
access to conduct legitimate business for Minnesota Management & Budget and to taxing authorities. You are not legally obligated to
provide it. However, we may not be able to process this transaction without it.