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Revis
ed:05/21/19
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Claim #:
AFFIDAVIT OF RELEASE BY HEIR
STATE OF ______________________ )
COUNTY OF_____________________)
BEFORE ME, on this _____ day of ____________, 20____, personally
appeared, ________________________ known to me to be a credible person and
(Name of Affiant)
of lawful age, who being by me first duly sworn, on [ his or her ] oath deposes and stated
the following:
I release my share of the property to _______________, ________________,
(Name of Recipient) (Relationship)
to claim on my behalf.
I declare under penalty of perjury under the law of the State of Nevada, that the
foregoing is true and correct.
IN WITNESS WHEREOF, I/We hereunto subscribe my name this _____ day
of ____________, 20_____.
BY: ______________________
(Affiant)
Notary Signature: _____________________________
My Commission expires: ___________________________
ATTACH A COPY
OF A CURRENT GOVERNMENT-ISSUED PHOTO ID
MAIL COMPLETED FORM TO: NEVADA UNCLAIMED PROPERTY
555 E WASHINGTON AVE STE 4200
LAS
VEGAS NV 89101-1070
This form is to be used only by siblings or other heirs who wish to release their
portion of the funds to one claimant.
To inquire about the amount you are
releasing, contact us at 702-486-4140 or
Unclaimedproperty@nevadatreasurer.gov
