Owner Name (first, middle, last, suffix)
Date of Death
Place of Death
County: State:
I being first duly sworn, on oath, depose and say:
1. The above named person died more than 30 days prior to the execution of this affidavit.
2. The value of all the personal property in the decedent's estate, wherever located, less liens and encumbrances, does
not exceed $75,000.00.
3. Affiant is the successor of the decedent, entitled to decedent's property by will or intestate succession.
4. An application or petition for the appointment of a personal representative is not pending or has not been granted in
any jurisdiction, or, if granted, the personal representative has been discharged or more than one year has elapsed
since a closing statement has been filed and the amount is not exceeding $75,000.00.
5. Decedent owned a motor vehicle, described as follows:
Vehicle Identification Number
Body Style
Plate Number
6. The affiant is entitled to receive payment of any debt due the decedent, and to receive the decedent's tangible
personal property or an instrument evidencing the transfer to the affiant of any debt, obligation, stock or chose in
action belonging to decedent.
This affidavit is made pursuant to Section 14-3971, Arizona Revised Statutes as amended, for the purpose of making
claim to property of the above named decedent under said statute.
Affiant Name (first, middle, last, suffix)
Affiant Signature
Subscribed and sworn to
before me this date.
Notary or MVD Agent Signature
Commission Expires
for Obtaining Title to the Vehicle of an Arizona Decedent
32-6901 R01/14