Widows Affidavit For Disposition Of Estates {POA-30}

) ) SS: County of _________________) POA-30 SF# 49376 Rev 6/00 State of Indiana WIDOW'S AFFIDAVIT FOR DISPOSITION OF ESTATES, PURSUANT TO I.C. 29-1-8-1 __________________________________________, after having been first duly sworn according to law says: 1. That the affiant is the widow or widower of __________________________________________, deceased. 2. That the said decedent departed this life (testate) (intestate), on the ________day of _______________, (Circle one) _______, a resident of the State of ________________. Year 3. That the value of the entire assets of the estate of said decedent does not exceed the sum of $25,000.00. 4. That no petition for the appointment of a personal representative for the estate of said decedent is pending or has been granted. 5. That 45 days have elapsed since the death of the said decedent. 6. That there is in the possession of the Auditor of the State of Indiana, property of said decedent described as follows: Warrant No. ________________ in the amount of $ ___________. Warrant No. ________________ in the amount of $ ___________. 7. That your affiant is entitled to receive said monies (under the will of said decedent) (under the statutes of (Circle one) intestate succession of the State of _____________________.) And further affiant say not. _______________________________________________ (Signature) Subscribed and sworn to before me, a Notary Public, this ________ day of _________________, _________. Year _______________________________________________ (Signature) Notary Public (Printed)________________________________________ My Commission expires: _____________________________. Resident of __________________________________County. Mail completed form to: State Auditor's Office, State House, Rm. 234B, Indianapolis, IN 46204. American LegalNet, Inc. www.FormsWorkflow.com