Small Estate Affidavit Page 4

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11.
The property described in paragraph 6 of this affidavit would be distributed
as follows:
Specific sum or property
Name
to be distributed
The foregoing statement is made under the penalties of perjury.*
_______________________________________________
Signature of affiant
*(Note:
A FRAUDULENT STATEMENT MADE UNDER THE PENALTIES OF PERJURY IS PERJURY, AS DEFINED
IN THE SECTION 32.2 OF THE CRIMINAL CODE OF 1961.)
Name________________________________________________________________________________________
Business Address____________________________________________________________________________
City, State, Zip Code_________________________________________________________________________
Telephone number___(
)
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