Fillable Printable Small Estate Affidavit for Nonresident Decedents

Small Estate Affidavit for Nonresident Decedents

Small Estate Afdavit for

Nonresident Decedents

This Afdavit may be used if the owner of the unclaimed personal property at issue was not a resident of the State of

Washington on the date of his or her death. Claimants should use the “Afdavit of Successor” form if the owner was a

resident of the State of Washington at the time of his or her death.

REV 80 0053 (8/29/13)

Use this form if the following is true to the best of your knowledge

• That the name and address of the undersigned claimant are as follows:

Decedent’s Name:

Claimant’s Name:

Address:

City: State: Zip:

• The decedent was, at the time of their death, a resident of the state of .

(Attachedtothisafdavitisaphotocopyofthedecedent’sdeathcerticate.)

• Thedecedentdidnotleaveawill.

• The estate was not probated.

• Noapplicationorpetitionfortheappointmentofapersonalrepresentativeispendingorhasbeengrantedinany

jurisdiction.

Property description

The undersigned claimant claims the following personal property, which property is subject to probate:

Your Responsibility

As the claimant you are responsible for understanding the small estate laws in the state where the deceased was a resident.

Youareresponsibleforthefundswepayyouandifanotherlegitimateheircomesforward,youwillhavetopaythemtheir

portionofthefundsyoureceived.

The undersigned claimant bears responsibility for following the laws of the decedent’s state of residence and agrees to

indemnifyandholdharmlesstheStateofWashingtonagainstanyliabilityarisingfromtheState’spaymentordeliveryofthe

property to the undersigned claimant.

Dated this day of , (yr)

Subscribedandsworn(orafrmed)toby:

(Claimant) before me this

day of , (yr)

(Claimant’s Signature)

(Notary Signature)

Notary in and for the State of

My commission expires

Residing at

Company Reporting Property Property/Amount Claimed

(Seal)