700-00027 – Affidavit of No Assets (07/2018) Page 1 of 1

STATE OF VERMONT

SUPERIOR COURT PROBATE DIVISION

Unit Docket No.:

In re:

AFFIDAVIT OF NO ASSETS

Petitioner _________________________________________, being duly sworn states as follows:

1. That he/she is the ______________________________ of ___________________________, deceased,

late of _____________________________________, Vermont, who died on __________________, and that _______________________________ was nominated to be Executor under the purported Last Will and Testament of the late _______________________________.

2. That the Petitioner is well acquainted with the personal affairs of the late _________________________ and

to the best of his / her knowledge and all information available to him / her, that there are no assets to be distributed at the time of death.

3. A certified copy of the death certificate is attached to this petition.

Accordingly, I believe the establishment of an estate for ____________________________________ is unnecessary.

_______________________________ ______________________________________________ Date Signature of Petitioner

______________________________________ ______________________________________________ Relationship to Decedent Printed Name

______________________________________ ______________________________________________ Mailing Address Telephone/Email

Signed and sworn to before me:

Date Signature of Notary Expiration Date