Introduction

I, [YOUR NAME], am the [RELATIONSHIP TO THE DECEDENT] of the deceased, [DECEDENT'S NAME], who passed away on [DECEDENT'S DEATH DATE]. I hereby declare under penalty of perjury under the laws of the State of Nebraska that the following statements are true and correct to the best of my knowledge and belief:

Statements

1. The total value of the assets of the estate of the deceased, to the best of my knowledge, is below the threshold required for formal probate proceedings in the State of Nebraska.

2. I am entitled to receive property from the estate of the deceased as [LEGAL ENTITLEMENT].

3. There is no will or testamentary document governing the disposition of the deceased's assets to the best of my knowledge.

4. I have attached a list of the assets of the deceased, including but not limited to bank accounts, vehicles, and personal property, along with their estimated values.

5. I request that the assets of the deceased be transferred to me in accordance with Nebraska Revised Statutes, Section 30-24,127, using the Small Estate Affidavit procedure.

6. I understand that by signing this affidavit, I am legally responsible for the proper distribution of the deceased's assets to the lawful heirs.

I hereby request that you accept this Small Estate Affidavit as sufficient authority for the transfer of the assets of the deceased to me, in accordance with the laws of the State of Nebraska.

If you require any further information or documentation, please do not hesitate to contact me at [YOUR EMAIL].

Thank you for your prompt attention to this matter.

Signatures

[YOUR NAME]

[WITNESS' NAME]

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