Introduction

I, [YOUR NAME], hereby declare under penalty of perjury that I am a beneficiary of the estate of [DECEDENT'S NAME], who passed away on [DECEDENT'S DEATH DATE].

I further affirm that to the best of my knowledge and belief, the total value of the deceased's estate, including all personal property, tangible and intangible, and real property, does not exceed the statutory threshold for a small estate under Louisiana law.

Statements

As a beneficiary, I am entitled to the bank account held at your institution:

• Account Holder: [DECEDENT'S NAME]

• Account Number: [ACCOUNT NUMBER]

• Account Type: Savings Account

I request that the above-listed account(s) be transferred to my name, [YOUR NAME], as the rightful beneficiary of the deceased's estate. I understand that by signing this affidavit, I assume responsibility for any debts or liabilities of the deceased to the extent of the assets received.

I hereby indemnify and hold harmless [BANK NAME] and its officers, agents, and employees from any claims, demands, or liabilities arising out of the transfer of the above-mentioned account in reliance on this affidavit.

I declare that the statements made herein are true and correct to the best of my knowledge, information, and belief, and I understand that making false statements in this affidavit may subject me to penalties under Louisiana law.

Signature

Executed on this [DATE] at [CITY NAME], Louisiana.

[YOUR NAME]

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