AFFIDAVIT FOR COLLECTION OF ALL PERSONAL PROPERTY STATE OF ARIZONA ) MARICOPA COUNTY ) By signing this affidavit, I swear or affirm under penalty of perjury that its contents are true and correct. 1. INFORMATION ABOUT THE DECEASED (THE PERSON WHO DIED): Name of person who died: Date of death: Place of death: Maricopa County, Arizona 2. 30-DAY REQUIREMENT: More than thirty (30) days have gone by since the person died. 3. RELATIONSHIP: My relationship to the person who died is: (explain) 4. VALUE OF PERSONAL PROPERTY. The value of all the personal property in the deceased person’s estate, wherever located, minus the amount of liens and encumbrances on the property, is not greater than $50,000.00. 5. PERSONAL REPRESENTATIVE. To the best of my knowledge, no one has filed an Application or Petition for Appointment of a Personal Representative and no Application or Petition has been granted in any state OR if an application has been granted the personal representative has been discharged or more than one year has elapsed since a closing statement has been filed and the amount does not exceed $50,000. 6. ENTITLEMENT. I am the claiming successor to the personal property and I am entitled to payment or delivery of the property because I am. (Check all boxes that apply.) I am named in the Will of the person who died, a copy of which is attached to this Affidavit. The deceased had no Will, but I am entitled to the property under law because (check ONE) I am the spouse of the person who died; I am a child of the person who died, and there is no surviving spouse, or there is a surviving spouse but he or she is not my parent and the deceased had separate or community property; I am the parent of the person who died, and there is no surviving spouse or child; I am a brother or sister of the person who died, and there is no surviving spouse, child or parent. The person died without a will and I am the sole heir. The person died without a will and the people with equal or greater right than I have to the property have all assigned their entire interests in the estate to me, which is proven by the copy of the documents they signed to this effect that I am attaching to this affidavit. The person died and left a valid Will and the people with equal or greater right than I have to the property have all assigned their entire interests in the estate to me, which is proven by the copy of the documents they signed to this effect that I am attaching to this affidavit. © Superior Court of Arizona in Maricopa County March 13, 2009 ALL RIGHTS RESERVED PBSE11f Page 1 of 2 Use only most current version AFF American LegalNet, Inc. www.FormsWorkflow.com Case No. 7. DESCRIPTION OF PROPERTY. The person who died owned the following personal property. (List all property. Attach extra pages if necessary.) Description Value Location, or Who Has Property Now $ $ $ $ $ TOTAL VALUE: $ 8. MONEY OWED: The person who died was entitled to collect on the following debts from persons located in Arizona. (List all. Attach extra pages if necessary.) Description Amount owed Name of Who Owes the Debt $ $ $ $ TOTAL AMOUNT OWED: $ 9. This affidavit is made under Arizona Law, Sec. 14-3971(B), Arizona Revised Statutes, for the purpose of making claim to personal property of the person who died. OATH OR AFFIRMATION The contents of this document are true and correct under penalty of perjury. Date Signature of Person Making Affidavit Printed Name Sworn to or Affirmed before me this date: Date (Seal/My Commission Expires) Deputy Clerk of Court or Notary Public © Superior Court of Arizona in Maricopa County March 13, 2009 ALL RIGHTS RESERVED PBSE11f Page 2 of 2 Use only most current version AFF American LegalNet, Inc. www.FormsWorkflow.com