Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
Lawyer’s Bar Number:
Licensed Fiduciary Number: _____________________________________
Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
AFFIDAVIT FOR COLLECTION OF
ALL PERSONAL PROPERTY
STATE
OF ARIZONA )
________________ COUNTY )
By signing this affidavit, I swear or affirm under penalty of perjury that its contents are true and
correct.
1. INFORMATION ABOUT THE DECEASED (THE PERSON WHO DIED):
Name of person who died:
Date of death:
Place of death:
2. 30-DAY REQUIREMENT: More than thirty (30) days have gone by since the person died.
3. RELATIONSHIP: My relationship to the person who died is: (explain)
4. VALUE OF PERSONAL PROPERTY. The value of all the personal property in the deceased
person’s estate, wherever located, minus the amount of liens and encumbrances on the property, is not
greater than $75,000.00.
5. PERSONAL REPRESENTATIVE. To the best of my knowledge, no one has filed an Application or
Petition for Appointment of a Personal Representative and no Application or Petition has been granted in
any state OR if an application has been granted the personal representative has been discharged or more
than one year has elapsed since a closing statement has been filed and the amount does not exceed
$75,000.00.
For Clerk’s Use Only
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ALL RIGHTS RESERVED
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6. ENTITLEMENT. I am the claiming successor to the personal property and I am entitled to payment or
delivery of the property because I am. (Check all boxes that apply.)
I am named in the Will of the person who died, a copy of which is attached to this Affidavit.
The deceased had no Will, but I am entitled to the property under law because (check ONE)
I am the spouse of the person who died;
I am a child of the person who died, and there is no surviving spouse, or there is a surviving
spouse but he or she is not my parent and the deceased had separate or community
property;
I am the parent of the person who died, and there is no surviving spouse or child;
I am a brother or sister of the person who died, and there is no surviving spouse, child or
parent.
The person died without a will and I am the sole heir.
The person died without a will and the people with equal or greater right than I have to the property
have all assigned their entire interests in the estate to me, which is proven by the copy of the
documents they signed to this effect that I am attaching to this affidavit.
The person died and left a valid Will and the people with equal or greater right than I have to the
property have all assigned their entire interests in the estate to me, which is proven by the copy of
the documents they signed to this effect that I am attaching to this affidavit.
7. DESCRIPTION OF PROPERTY. The person who died owned the following personal property. (List
all property. Attach extra pages if necessary.)
Description Value Location, or Who Has Property Now
$
$
$
$
$
TOTAL VALUE: $
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ALL RIGHTS RESERVED
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8. MONEY OWED: The person who died was entitled to collect on the following debts from persons located
in Arizona. (List all. Attach extra pages if necessary.)
Description Amount owed Name of Who Owes the Debt
$
$
$
$
TOTAL AMOUNT OWED: $
9. This affidavit is made under Arizona Law, Sec. 14-3971(B), Arizona Revised Statutes, for the purpose of
making claim to personal property of the person who died.
OATH OR AFFIRMATION:
The contents of this document are true and correct under penalty of perjury.
Signature of Person Making Affidavit Date
________________________________________
Printed Name
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this: by
(date)
.
(notary seal)
Notary Public
PBSE11f - 082515
ALL RIGHTS RESERVED
AFF
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