AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY Minnesota Statutes § 524.3-1201 Estate of: _______________________________________, Decedent. STATE OF MINNESOTA COUNTY OF ) ) SS ) I, state that: 1. My name is: ____________________________________________________________. 2. My address is: __________________________________________________________. 3. Decedent died on ______________________. A certified copy of Decedent's death certificate is attached to this Affidavit. I am the successor of the Decedent and I have legal standing to complete this form 4. because: ____________________________________________________________________ _____________________________________________________________________________. 5. The value of the probate estate, determined as of the date of death, wherever located, involving any contents of a safe deposit box, less liens and encumbrances, does not exceed $75,000. 6. Thirty days have elapsed since the death of the Decedent, or in the event the property to be delivered is the contents of a safe deposit box, 30 days have elapsed since the filing of an inventory of the contents of said box. 7. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. I, as claiming successor, am entitled to payment or delivery of the following described 8. property: _____________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. Dated: _______________________ (Signature of person who filled out this form) E-mail address Sworn/affirmed before me this Day of , Notary Public / Deputy Court Administrator PRO202 State ENG Rev 8/16 www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com