Affidavit for Collection of Personal Property
The undersigned state(s) as follows:
1. _______________________________________ died on ___________, 20____, in the County of
_____________________________, State of ________________.
2. At least 40 days have elapsed since the death of the decedent, as shown in a certified copy of the decedent's
death certificate attached to this affidavit or declaration.
No proceeding is now being or has been conducted a for administration of the decedent's estate.
The decedent's personal representative has consented in writing to the payment, transfer, or delivery to
the affiant or declarant of the property described in the affidavit or declaration.
4. The current gross fair market value of the decedent's real and personal property does not exceed one
hundred fifty thousand dollars ($150,000).
An inventory and appraisal of the real property included in the decedent’s estate is attached.
There is no real property in the estate.
6. The following property to be transferred, delivered, or paid to the affiant under the provisions of local
7. The successor(s) of the decedent is/are:
8. The undersigned
The affiant or declarant is the successor of the decedent to the decedent's interest in the described
The affiant or declarant is authorized to act on behalf of the successor of the decedent with
respect to the decedent's interest in the described property.
9. No other person has a superior right to the interest of the decedent in the described property.
The affiant or declarant requests that the described property be paid, delivered, or transferred to the affiant
The affiant or declarant affirms or declares under penalty of perjury that the foregoing is true and correct.