Small Estate Affidavit Page 2

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7. That at least forty-five (45) days have elapsed since the death of the decedent.
8. That no application or petition for the appointment of a personal representative is pending
or has been granted in any jurisdiction.
THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY.
________________________________________
Signature of Affiant
STATE OF INDIANA
COUNTY OF ________________
Before me, _____________________, (title of officer) this ____ day of _______________,
____, ________________ acknowledged the execution of the annexed ___________________
(name of instrument).
___________________________________
Notary Public, State of _________________
Printed Name: ________________________
Commission Expires: _________________
2

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