AFFIDAVIT FOR COLLECTION OF ALL PERSONAL PROPERTY 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: ______________________________________ (County, State) 2. 3. 30 DAY REQUIREMENT. More than thirty (30) days have gone by since the person died. RELATIONSHIP. My relationship to the person who died is: ______________________________________ ______________________________________________________________________________________ 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 $75,000. 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 $75,000. ENTITLEMENT. I am the claiming successor to the personal property and I am entitled to payment or delivery of the property because: (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, who are listed above, 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, who are listed above, 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. 5. 6. Page 1 of 2 Revised: 9/18/2013 American LegalNet, Inc. www.FormsWorkFlow.com 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, §14-3971(B), Arizona Revised Statutes, for the purpose of making claim to personal property of the person who died. OATH OR AFFIRMATION STATE OF ARIZONA MOHAVE COUNTY ) ) ss. The contents of this document are true and correct under penalty of perjury. Signature: _____________________________________________ (Person Making Affidavit) Date:_________________________ SUBSCRIBED AND SWORN TO before me this _____________, day of _________________, 20________ By:_______________________________________ (Printed Name) My Commission Expires:______________________ ____________________________________ Notary Public Page 2 of 2 Revised: 9/18/2013 American LegalNet, Inc. www.FormsWorkFlow.com