Free pc598.p65 - Michigan

Approved, SCAO

AFFIDAVIT OF DECEDENT'S SUCCESSOR FOR DELIVERY OF CERTAIN ASSETS OWNED BY DECEDENT

Estate of 1. I am decedent's successor assurviving devisee under the will dated fiduciary or representative of 2. Decedent died a resident of
Name

spouse .

adult child

other heir

specify

who is an heir or devisee and has a legal incapacity. on
Date

City, township, or village and county and state

.

More than 28 days have passed since decedent's death. 3. No real property is included in the estate. 4. Decedent's estate, less liens and encumbrances, does not exceed $15,000 (as adjusted for cost of living as provided in MCL 700.1210). 5. An application/petition for the appointment of a personal representative is not pending or has not been granted in any jurisdiction. A petition for assignment of an estate not exceeding $15,000 (as adjusted for cost of living) has not been filed with a court. 6. I am entitled to payment or delivery of the following property: 7. The name and address of each other person entitled to a share of the property and his/her proportion is as follows: NAME ADDRESS RELATIONSHIP SHARE % .

8. A copy of the death certificate is attached.
Signature Name (type or print) Address City, state, zip

Subscribed and sworn to before me on My commission expires:

Date

, Signature:

County, Michigan.

Notary public, State of Michigan, County of NOTICE: A false statement on this affidavit may subject the person swearing to the statement to prosecution for perjury.
MCL 700.3983 PC 598 (9/05)

AFFIDAVIT OF DECEDENT'S SUCCESSOR FOR DELIVERY OF CERTAIN ASSETS OWNED BY DECEDENT