AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY STATE OF ARIZONA ) ) ss. ) COUNTY OF , State of , being duly sworn, on oath deposes and says: died on , in the County of , more than thirty days prior to execution of this Affidavit. Check either 1(a) or 1(b): 1. (a) Affiant is the successor of the decedent, entitled to decedent’s property by Will or intestate succession and the value of all of the personal property in the decedent’s estate, wherever located, less liens and encumbrances, does not exceed Fifty Thousand Dollars ($50,000). (b) Affiant is claiming as the surviving spouse dependent child of decedent and the value of all personal property in the decedent’s estate, wherever located, less liens and encumbrances, does not exceed the greater of either Fifty Thousand Dollars ($50,000) or the total sums permitted as the allowance in lieu of homestead, exempt property, and the family allowance, pursuant to Arizona Revised Statutes, in effect on the date of the decedent’s death. Check either 2(a) or 2(b): 2. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. (b) 02/04/00 (a) A personal representative has been appointed and EITHER has been discharged OR more than one year has elapsed since a closing statement was filed AND, as of the date of this Affidavit, Fifty Thousand Dollars ($50,000) has not been exceeded. 1 of 2 2001 © American LegalNet, Inc. 3. Decedent owned the following personal property: 4. The affiant is entitled to receive payment of any debt due the decedent and to receive decedent’s tangible personal property or an instrument evidencing the transfer to affiant of any debt, obligation, stock or chose in action belonging to decedent. This Affidavit is made pursuant to A.R.S. §14-3971, as amended, for the purpose of making claim to property of the decedent under said statute. Date Affiant’s Signature Affiant’s Printed Name SUBSCRIBED AND SWORN TO before me on . My Commission Expires: Notary Public 02/04/00 2 of 2 2001 © American LegalNet, Inc.