Minnesota Affidavit For Collection of Personal Property

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
$50,000.
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.
8.
I, as claiming successor, am entitled to payment or delivery of the following described
property: _____________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
Dated: _______________________
___________________________________________
(Signature of person who filled out this form)
Notarial stamp or seal (or other title rank)
Signed and sworn to (or affirmed) before me on
_______________________________(date)
By:
by:___________________________________________.
(Print name of the person that signed this form)
______________________________________________
SIGNATURE OF NOTARY PUBLIC OR OTHER OFFICIAL
PRO202
State
ENG
Rev 8/09
www.mncourts.gov/forms
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