Free Connie-B.wpt - North Dakota

ND PROBATE CODE FORM 1 Page 1

10/01/03

AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY OF THE DECEDENT. (N.D.C.C. 30.1-23-01). Name, Address, and Telephone No. of Attorney Space below for use of District Court only Probate No. _______________

Attorney ___________________ for:

IN THE DISTRICT COURT OF _________________________ COUNTY, STATE OF NORTH DAKOTA In the Matter of the Estate of _________________________________________________________, Deceased. AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY OF THE DECEDENT
STATE OF NORTH DAKOTA } } } County of ___________________ }

SS.

_________________________________________________________________, being duly sworn, states the following: 1. I am the successor of __________________________________________________________________________ who died on _________________________________, ______________, because: 2. The value of the entire estate of the decedent, wherever located, less liens and encumbrances, does not exceed $50,000. 3. Thirty (30) days have elapsed since the death of the decedent. 4. No application or petition for the appointment of a personal representative of the decedent's estate is pending or has been granted in any jurisdiction. 5. (a) As successor of the decedent, I am entitled to the payment of any sums of money due and owing the decedent and to the delivery of all tangible personal property belonging to the decedent and to the delivery of all instruments evidencing a debt, obligation, stock or chose in action belonging to the decedent. As successor of the decedent, I am entitled to payment or delivery of*

(b)

Page 1 of NDPC FORM 1

ND PROBATE CODE FORM 1 Page 2

10/01/03

___________________________________________________________________________________________________ ___________________________________________________________________________________________________ belonging to the decedent and presently held by: ___________________________________________________________________________________________________ ___________________________________________ Affiant Subscribed and sworn to before me this ____________ day of _____________________________, __________. ____________________________________________ Notary Public My Commission expires: ___________________________ ______________________ County, North Dakota

(SEAL)

*Specify debt, personal property, instrument, obligation, stock or chose in action.

Page 2 of NDPC FORM 1