AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY Minnesota Statutes § 524.3-1201
Estate of: _______________________________________, Decedent.
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. 4. I am the successor of the Decedent and I have legal standing to complete this form 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 $20,000. 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. No application or petition for the appointment of a personal representative is pending or 7. has been granted in any jurisdiction. I, as claiming successor, am entitled to payment or delivery of the following described 8. property: _____________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________.
Notarial stamp or seal (or other title rank)
(Signature of person who filled out this form) Signed and sworn to (or affirmed) before me on _______________________________(date) by:________________________________. (Print name of the person that signed this form) ______________________________________________
SIGNATURE OF NOTARY PUBLIC OR OTHER OFFICIAL
NOTE: Submit this Affidavit in duplicate or as required by Minnesota Statute 524.3-1201.
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