Introduction

I, [YOUR NAME], of [YOUR ADDRESS], being duly sworn, hereby depose and state as follows in support of my application for a Kansas Small Estate Affidavit to claim the assets of my deceased spouse, [DECEASED SPOUSE'S NAME].

Statement of Facts

1. My spouse, [DECEASED SPOUSE'S NAME], passed away on [DATE OF DEATH] in [CITY], Kansas.

2. At the time of their death, my spouse was a resident of [CITY], Kansas.

3. My spouse did not leave a will.

4. To the best of my knowledge, the total value of my spouse's estate, including all personal property and assets, does not exceed $40,000.

5. I am the surviving spouse of the deceased and have a legal interest in their estate.

6. I am not aware of any other person having a superior right to claim the assets of the deceased.

Sworn Oath

I solemnly swear under penalty of perjury that the information provided in this affidavit is true and correct to the best of my knowledge, information, and belief.

Executed this [DATE OF EXECUTION] in [CITY], Kansas.

[YOUR NAME]

Witness

I, the undersigned, hereby certify that [YOUR NAME], personally known to me, appeared before me this day and acknowledged the foregoing instrument to be their free and voluntary act and deed.

[WITNESS NAME]

Date: [DATE SIGNED]

Notarization

State of Kansas

County of [COUNTY]

On this [DATE OF NOTARIZATION], before me, a Notary Public in and for said county and state, personally appeared [YOUR NAME], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes therein contained.

[NOTARY PUBLIC NAME]

My Commission Expires: [COMMISSION EXPIRY DATE]

[NOTARY PUBLIC SEAL]

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