Through the execution of this form, an applicant declares under oath that the value of her/his estate is below $50,000. Assessed value disregards location but considers liens and encumbrances. A copy of the affidavit must be forwarded to the Department of Revenue. Inheritance tax dues must also be paid. Download
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1 SMALL ESTATE AFFIDAVIT Collection of Personal Property South Dakota I, ____________________________________________________________________, upon being duly sworn, state on my oath that: 1. My post office address is: ___________________________________________________ 2. My residence address is: ___________________________________________________ 4. Thirty days have elapsed since the death of the decedent; 5. No application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 7. A copy of the affidavit will be furnished to the Department of Revenue and any inheritance tax due will be paid; and 8. The claiming successor is entitled to payment or delivery of the property. 9. The decedent's name is ____________________________________________________ and the decedent resided at ________________________________________________. 10. I am entitled to payment or delivery of the property hereby claimed. THE FOREGOING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY. ________________________________________ Signature of Affiant State of South Dakota ) County of ____________ ) 3. The value of the entire estate, wherever located, less liens and encumbrances, does not exceed fifty thousand dollars ($50 ,000 ); 6. The decedent has not incurred any indebtedness to the South Dakota Department of Social Services for medical assistance for nursing home or other medical institutional care; 2 Acknowledgment of Individual STATE OF SOUTH DAKOTA COUNTY OF _________________ On this ____ day of _________________, in the year __________, before me personally appeared ______________________________________, known to me (or proved to me on the oath of ______________________________) to be the person who is described in, and who executed the within instrument and acknowledged to me that ______________ he/she/they executed the same. ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Disclaimer This form is provided without any warranty, express or implied, as to its legal effect and completeness. Please use at your own risk. If you have a serious legal problem, we suggest that you consult an attorney.