Small Estate Affidavit for Credit Union Accounts

Decedent Information

Decedent's Full Name

Date of Death

Last Known Address

Credit Union Account Number(s)

Affiant Information

Affiant's Full Name

Relationship to Decedent

Affiant's Address

Affiant's Phone Number

Estate Information

Total Value of Estate

List of Estate Assets (include credit union accounts)

List of Known Debts

Heir(s) Information

List All Legal Heirs (Name, Relationship, Address)

I, the undersigned, solemnly affirm that I am authorized under state law to claim the assets in the above-mentioned credit union accounts as the lawful successor or representative of the estate of the decedent, and that the foregoing information is true and complete to the best of my knowledge.

Affiant Signature

Date

Notary Public

State of

County of

Subscribed and sworn to before me on

Notary Public Signature

Commission Expiration