STATE OF IOWA

COUNTY OF [NAME OF COUNTY]

I, [YOUR NAME], being of lawful age, do hereby solemnly affirm and declare the following facts to be true and correct to the best of my knowledge and belief:

Statement of Facts

1. That [DECEASED INDIVIDUAL'S NAME], of [CITY] in Iowa, passed away on [DATE OF DEATH].

2. That to the best of my knowledge, the total value of the assets of the estate of the deceased, including real and personal property, does not exceed the sum of $[VALUE].

3. That the surviving heirs of the deceased, as set forth in the attached list, are entitled to the estate in accordance with the laws of intestate succession in the State of Iowa.

4. That there is no legal representative appointed for the estate, and I am willing to act as affiant in this matter.

5. That there are no outstanding debts or claims against the estate to the best of my knowledge.

6. That the estate assets shall be distributed among the surviving heirs in accordance with Iowa law.

7. That I make this affidavit for the purpose of establishing the right of the heirs to collect, transfer, or encumber the assets of the estate.

Oath and Declaration

I hereby make this affidavit to assist in establishing the right of the heirs to collect, transfer, or encumber the assets of the estate.

Signature

Signed and sworn before me this [DATE], at [LOCATION].

[Your Name]
AFFIANT

[Notary Public's Name]

NOTARY PUBLIC

STATE OF IOWA

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