Small Estate Affidavit (Rcw 11.62.010) (Page 4 of 4) in pdf

Small Estate Affidavit (Rcw 11.62.010) Page 4

Declaration under Penalty of Perjury

I declare under penalty of perjury under the laws of the State of Washington that the

following is true and correct to the best of my knowledge:

1. Name & Address. My name and address are as shown below.

2. Receipt of Small Estate Affidavit. I have received a copy of the Small Estate

Affidavit dated

, in which the Claimant

declares

that he/she is a Claiming Successor of the Decedent

3. Claiming Successor. I am also a "successor" of Decedent as defined in RCW

11.62.005.

4. Authorization. I authorize the Claimant to receive full payment or delivery of

the property claimed on my behalf.

5. Accounting. I am providing this authorization to the Claimant in consideration of

his/her promise to me that he/she will account to me for all payments or deliveries

of property received under his/her Small Estate Affidavit within five (5) business

days of its receipt. This Paragraph 5 concerns the rights and liabilities between

only the Claimant and me. No possessor of any property claimed has any

responsibility to see to the application of any property transferred to the Claimant.

SIGNED

Date:

___________________________________

Place: At

___________________________________

Signature:

___________________________________

Another Claiming Successor of Decedent

Printed Name: ___________________________________

Address:

___________________________________

Declaration of Another Claiming Successor to Decedent's Personal Property

RCW 11.62.010

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Small Estate Affidavit (Rcw 11.62.010) Page 4