STATE OF INDIANA )
)SS:
COUNTY OF __________________)
IN RE THE ESTATE OF: )
)
)
______________________________ )
AFFIDAVIT FOR TRANSFER OF ASSETS WITHOUT ADMINISTRATION
The undersigned Affiant states that:
1. The above decedent died on the ______ day of _______________________, 20____,
while domiciled in ____________________ County, Indiana.
2. No application or petition for the appointment of a personal representative of
said decedent’s estate is pending or has been granted in any jurisdiction.
3. More than forty-five (45) days have elapsed since the death of said decedent.
4. The value of the gross probate estate of said decedent, wherever located (less
liens, encumbrances and reasonable funeral expenses) does not exceed fifty thousand
dollars ($50,000.00).
5. The person or persons set forth in paragraph 6 below are entitled to payment or delivery
of the property as set forth after their names, by reason of:
☐ Being a beneficiary under the Will of said decedent, which was probated as
recorded in the office of the Clerk of ________________ County
____________________________ Court, _____________________ County, Indiana on
the ____ day of ____________________, 20____, a copy of which is attached as Exhibit
A.
☐ Being the surviving spouse, dependent child, or children of said decedent.
☐ Other reasons:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. The following person or persons are entitled to receive, without administration, the
following listed property from the person, firm, or corporation shown after said property, subject
to liens and encumbrances.
THE INDIANA COUNTY IN WHICH YOU WILL
USE THIS FORM
THE NAME OF THE PERSON WHO HAS PASSED AWAY.
THAT PERSON IS KNOWN AS THE DECEDENT
FILL IN THE DAY, MONTH AND YEAR OF THE
DECEDENT'S DEATH
NAME OF COUNTY THE DECEDENT LIVED IN WHEH HE/SHE PASSED
YOU CAN ONLY USE
THIS FORM IF IT HAS
BEEN 45 OR MORE
DAYS SINCE THE
DECEDENT PASSED
IF YOU ARE USING
THIS FORM AFTER A
WILL HAS BEEN FILED
IN COURT, CHECK
THIS FIRST BOX AND
FILL IN THE BLANKS.
ATTACH A COPY OF
THE WILL TO THIS
DOCUMENT.
IF THERE IS NO WILL,
BUT YOU ARE A
SPOUSE OR CHILD OF
THE DECEDENT,
CHECK THE SECOND
BOX
IF THERE IS ANOTHER REASON YOU ARE ABLE TO CLAIM PROPERTY OF THE DECEDENT, CHECK THE
THIRD BOX AND EXPLAIN HERE.
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