Affidavit For Collection Of Wages

AFFIDAVIT FOR COLLECTION OF WAGES STATE OF ARIZONA ) ) ss: COUNTY OF PINAL ) , being first duly sworn, on oath, deposes and says: 1. County of 2. 3. 4. , State of died on , 20 , in the . Affiant is the spouse of the decedent, or is authorized to act on behalf of the spouse. No application or petition for the appointment of a personal representative is pending or has been granted in this state. The affiant is entitled to receive payment of wages, salary or other compensation for personal services owed to the decedent, in an amount not in excess of FIVE THOUSAND DOLLARS ($5,000.00). This affidavit is made pursuant to A.R.S. §14-3971.A. as amended, for the purpose of making claim to such wages, salary or other compensation for personal services under said statute. DATED: Signature of Affiant SUBSCRIBED & SWORN TO before me this day of , 20 . Notary Public My commission expires: Superior Court of Arizona in Pinal County November 29, 2004 ALL RIGHTS RESERVED Page 1 of 1 PB3Personal Property Wages Use only most current version American LegalNet, Inc. www.FormsWorkflow.com