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THE ESTATE OF ) <br /> DECEASED ) <br /> AFFIDAVIT FOR COLLECTION OF <br /> PERSONAL PROPERTY OF THE DECEDENT <br /> STATE OF HAWAII ) <br /> COUNTY OF HAWAII ) <br /> I, being first duly sworn on oath,deposes and says: <br /> 1. Affiant is the successor of the above named decedent,who died on 120 <br /> A certified copy of the death certificate is submitted herewith. <br /> 2. No application or petition for the appointment of a personal representative is pending or has been granted in <br /> this State. <br /> 3. Affiant is entitled to payment or delivery of the below mentioned motor vehicle by virtue of Section 560:3-1201, <br /> Hawaii Revised Statutes, as amended, <br /> (License Plate) (MAKE) (BODY TYPE) <br /> (Vehicle Identification Number) <br /> and by virtue of(explain relationship of affiant to decedent) <br /> 4. Affiant has read and understands Section 560:3-1202, Hawaii Revised Statutes: <br /> §560:3-1202 Effect of affidavit. The person paying, delivering, transferring, or issuing personal <br /> property or the evidence thereof pursuant to section 560:3-1201 is discharged and released to the same <br /> extent as if the person dealt with a personal representative of the decedent. The person is not required <br /> to see to the application of the personal property or evidence thereof or to inquire into the truth of any <br /> statement in the affidavit. If any person to whom an affidavit is delivered refuses to pay, deliver, transfer, <br /> or issue any personal property or evidence thereof, it may be recovered or its payment, delivery, transfer, <br /> or issuance compelled upon proof of their right in a proceeding brought for the purpose by or on behalf of <br /> the persons entitled thereto. Any person to whom payment, delivery, transfer or issuance is made is <br /> answerable and accountable therefore to any personal representative of the estate or to any other person <br /> having a superior right. <br /> 5. Further affiant sayeth naught. <br /> Signature of Affiant <br /> (Place Notary Seal Here) STATE OF HAWAII NOTARY CERTIFICATION <br /> (Place Notary Seal Here) <br /> Subscribed and sworn to before me this Document Date: #of pages <br /> day of 20 Notary Name: Circuit <br /> Document Description: <br /> Notary Public, <br /> Judicial Circuit, State of <br /> My commission expires: Notary Signature Date <br /> Revised 07/07/09 <br /> Hawai'i County is an Equal Opportunity Provider and Employer <br />