State County
Name of Successor
Name of Successor
Name of Deceased
I/we are successor(s) of the deceased.
The fair market value of property owned by the decedent and subject to the disposition by will or
intestate succession at the time of his or her death, wherever that property is located, less liens and
encumbrances, does not exceed seventy thousand dollars ($70,000).
At least ten days have elapsed since the date of death of the decedent.
No application or petition for appointment of a personal representative is pending or has been
granted in any jurisdiction.
I/we as successor(s) of the decedent am/are entitled to the payment of any sums of money due and
owing to the decedent, and all tangible personal property belonging to the decedent including the
following described vehicle:
Death certicate must accompany small estate afdavit.
Year Make Model VIN
Signature Date
Signature Date
Subscribed and afrmed, or sworn to, before me this __________ day of ______________________ , 20 _______ , in
the county of ________________________________________________________________ , State of Colorado.
Notary Public Signature
Commission Expiration Date
DR 2712 (10/20/20)
Division of Motor Vehicles
Vehicle Services Unit
State of Colorado
Afdavit for Collection of Personal
Property Pursuant to Small Estate Proceeding
C.R.S. 15-12-1201