the Decedent's date of death and no application for the appointment of a personal representative for the Decedent is pending or has been granted in any jurisdiction.

8. The affiant hereby certifies that the information provided in this affidavit is true and correct to the best of their knowledge and belief. The affiant understands that any false statements made herein may subject them to penalties under the law.

9. The affiant further certifies that they are an interested party in the estate of the Decedent and have the legal right to file this affidavit.

10. This affidavit is executed in accordance with the laws of the State of West Virginia and is intended to facilitate the distribution of the Decedent's small estate without the need for formal probate proceedings.

11. Dated this ____ day of __________, 20___.

____________________________________
Signature of Affiant

____________________________________
Printed Name of Affiant

____________________________________
Address of Affiant

____________________________________
Phone Number of Affiant

12. Notary Public:

State of West Virginia
County of ______________

Subscribed and sworn to before me this ____ day of __________, 20___.

____________________________________
Notary Public Signature

My Commission Expires: ________________

(Seal)