AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY STATE OF ARIZONA PINAL COUNTY ) )ss. , being first duly sworn, do upon my oath, hereby state as follows: I 1. INFORMATION ABOUT PERSON WHO DIED: Name of person who died: Date of death: Place of death: 2. 30-DAY REQUIREMENT: More than thirty (30) days have elapsed 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 $75,000. 6. 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 person who died had no Will, but I am entitled to the property under law because (check ONE box): [ ] I am the spouse of the person who died; [ ] I am a living child of the person who died, and there is no living spouse; [ ] I am the living parent of the person who died, and there are no living children or spouse; [ ] I am a living brother or sister of the person who died, and there are no living children, spouse, or parents. [ ] 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 document(s) 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 Superior Court of Arizona in Pinal County July 8, 2009 ALL RIGHTS RESRVED PB Affidavit to Collect Personal Property Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com property, have all assigned their entire interests in the estate to me, which is proven by the document(s) they signed to this effect that I am attaching to this affidavit. 7. DESCRIPTION OF PROPERTY. The person who died owned the following personal property located in Arizona. (List all property; use extra paper 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; use extra paper if necessary) Description Amount owed Name of Who Owes the Debt $ $ $ $ TOTAL AMOUNT OWED: $ 9. This affidavit is made pursuant to Arizona Law, A.R.S. 14-3971(B), for the purpose of making claim to property of the person who died. Signature SUBSCRIBED AND SWORN TO before me this day of 20 By My Commission Expires: Superior Court of Arizona in Pinal County July 8, 2009 ALL RIGHTS RESRVED Deputy Clerk/Notary Public PB Affidavit to Collect Personal Property Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com