OTTAWA COUNTY PROBATE COURT Hours: Mon-Fri 8:00 AM-5:00 PM 12120 FILLMORE STREET Phone: 616-786-4110 WEST OLIVE, MI 49460 Website: www.miottawa.org

AFFIDAVIT OF DECEDENT’S SUCCESSOR FOR DELIVERY OF CERTAIN ASSETS OWNED BY

DECEDENT

COURT STAFF IS PROHIBITED BY LAW FROM GIVING LEGAL ADVICE, IF YOU HAVE ANY LEGAL QUESTIONS

DURING THIS PROCESS PLEASE CONTACT AN ATTORNEY.

**THIS FORM IS NOT FILED WITH THE PROBATE COURT**

Please consult Michigan Compiled Laws, Section 700.3983 or seek the advice of an attorney in regards to this procedure.

If a spouse, child, or other heir has been deceased for at least 28 days, there is a process that allows for distribution of property if the following applies:

When there is no real property included in the estate

The estate does not exceed $15,000 (less liens/encumbrances)**

There has been no estate or petition for assignment of an estate filed with the Probate Court

Step One: If all the above apply, you can fill out the Affidavit of Decedent’s Successor for Delivery of Certain Assets Owned by Decedent (PC 598).

** COLA amounts

YEAR 2010 $20,000 YEAR 2011 $20,000 YEAR 2012 $21,000 YEAR 2013 $21,000 YEAR 2014 $22,000 YEAR 2015 $22,000 YEAR 2016 $22,000 YEAR 2017 $22,000 YEAR 2018 $23,000 YEAR 2019 $23,000 YEAR 2020 $24,000

Estate of

AFFIDAVIT OF DECEDENT'S SUCCESSORFOR DELIVERY OF CERTAIN ASSETS OWNED BY DECEDENT

City, township, or village and county and state Date

specify

Name

PC 598 (9/11) AFFIDAVIT OF DECEDENT'S SUCCESSOR FOR DELIVERY OF CERTAIN ASSETS OWNED BY DECEDENT

Signature

Name (type or print)

Address

City, state, zip

Date

1. I am decedent's successor assurviving spouse adult child other heir

devisee under the will dated .

fiduciary or representative of who is an heir or devisee and has a legal incapacity.

2. Decedent died a resident of on .

More than 28 days have passed since decedent's death.

3. No real property is included in the estate.

4. Decedent's estate, less liens and encumbrances, does not exceed $15,000 (as adjusted for cost of living as provided in MCL700.1210).

5. An application/petition for the appointment of a personal representative is not pending or has not been granted in any jurisdiction.A petition for assignment of an estate not exceeding $15,000 (as adjusted for cost of living) has not been filed with a court.

6. I am entitled to payment or delivery of the following property: .

7. The name and address of each other person entitled to a share of the property and his/her proportion is as follows:

NAME ADDRESS RELATIONSHIP SHARE %

8. A copy of the death certificate is attached.

Subscribed and sworn to before me on ,

My commission expires: Signature:

Notary public,

NOTICE: A false statement on this affidavit may subject the person swearing to the statement to prosecution for perjury.

MCL 700.3983

Approved, SCAO

County and state or other jurisdiction where acting

County and state or other jurisdiction where commissioned