Amendment To Notice To Commissioner Regarding Possible Claims
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Amendment To Notice To Commissioner Regarding Possible Claims Form. This is a Minnesota form and can be use in Department Of Commerce Statewide.
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Tags: Amendment To Notice To Commissioner Regarding Possible Claims, 70.3.3, Minnesota Statewide, Department Of Commerce
(Top 3 inches reserved for recording data)
AMENDMENT TO NOTICE TO THE COMMISSIONER OF HUMAN
SERVICES REGARDING POSSIBLE CLAIMS (UNDER
MINN. STAT. 246.53, 256B.15, 256D.16 or 261.04)
AFTER CLOSING OF ESTATE
Minn. Stat. 524.3-801(d)(4)
Minnesota Uniform Conveyancing Blanks
Form 70.3.3 (2008)
DISTRICT COURT
PROBATE DIVISION
Judicial District
State of Minnesota
County of
Court File Number
In Re: Estate of
(Deceased)
AMENDMENT TO NOTICE TO THE COMMISSIONER OF HUMAN
SERVICES REGARDING POSSIBLE CLAIMS UNDER
MINN. STAT. 246.53, 256B.15, 256D.16 OR 261.04
AFTER CLOSING OF ESTATE
TO THE COMMISSIONER OF HUMAN SERVICES:
1. Decedent’s Full Name(s)
Date of Birth
Social Security Number
2. The estate previously served the Commissioner of Human Services with notice regarding possible claims (“Notice to the
Commissioner”).
3. An order or decree under Minn. Stat. 524.3-1001 or 524.3-1002 was entered in this estate, or a closing statement under
Minn. Stat. 523.3-1003 was filed in this estate on
.
(month/date/year)
Note: This form cannot be recorded independently. It must be attached to an Affidavit of Service of Amendment to Notice to
the Commissioner of Human Services Regarding Possible Claims After Closing of Estate (Form No. 70.3.6 Old Form No. 95-M)
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Minnesota Uniform Conveyancing Blanks Form 70.3.3
4. My name is
, and I have an interest
in the property legally described below, which was subject to administration by this estate: (insert legal description of the property)
Check here if all or part of the described real property is Registered (Torrens) □
5. The estate’s Notice to the Commissioner is amended as follows:
(Check and complete all applicable paragraphs; if paragraph C is checked, supply all items of information for each omitted spouse.)
A. Decedent:
Omitted/Corrected
Date of Birth
Variations/Other Names
Omitted/Corrected
Social Security Number
B. Predeceased spouse named in notice:
Spouse’s Name
Variations/
Other Names
C. Predeceased spouse not named in notice:
Name
(include all aliases, former names)
Omitted/Corrected
Date of Birth
Date of Birth
Omitted/Corrected
Social Security Number
Social Security Number
DATE:
(month/day/year)
(Signature of Person Filing Amendment)
Address:
Telephone:
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