Form Poa-30 (State Form 49396) - Widow'S Affidavit Form For Disposition Of Estates
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1State of Indiana
)
) SS:
County of _________________ )
POA-30
sf# 49376
(R2 / 6-09)
widow’s affidavit
for disposition of estates, pursuant to i.c. 29-1-8-1
__________________________________________, after having been first duly sworn according to law says:
1. That the affiant is the widow or widower of
__________________________________________, deceased.
2. That the said decedent departed this life (testate) (intestate), on the
________day of _______________,
(Circle one)
_______, a resident of the State of ________________.
Year
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 said decedent described
as follows:
Warrant No.
________________ in the amount of $ ___________.
Warrant No.
________________ in the amount of $ ___________.
7. That your affiant is entitled to receive said monies (under the will of said decedent) (under the statutes of
intestate succession of the State of
_____________________.)
(Circle one)
And further affiant 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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