Estate - Small Estate Affidavit

There are all sorts of forms executors, beneficiaries, and probate court clerks have to fill out and correspond with during probate and estate settlement, including affidavits, letters, petitions, summons, orders, and notices.

Estate - Small Estate Affidavit is a commonly used form within Tennessee. Here’s an overview of what the form is and means, including a breakdown of the situations when (or why) you may need to use it:

Atticus Fast Facts About Estate - Small Estate Affidavit

Sometimes it’s tough to find a quick summary— here’s the important details you should know about Estate - Small Estate Affidavit:

• This form pertains to the State of Tennessee

Government forms are not typically updated often, though when they are, it often happens rather quietly. While Atticus works hard to keep this information about Tennessee’s Form Estate - Small Estate Affidavit up to date, certain details can change from time-to-time with little or no communication.

Step 1 - Download the correct Tennessee form based on the name and ID if applicable

Double check that you have both the correct form name and the correct form ID. Some Tennessee probate forms can look remarkably similar, so it’s best to double, even triple-check that you’re using the right one! Keep in mind that not all States have a standardized Form ID system for their probate forms.

Step 2 - Complete the Document

Fill out all relevant fields in Form Estate - Small Estate Affidavit, take a break, and then review. Probate and estate settlement processes in TN are long enough to begin with, and making a silly error can push your timeline even farther back. No thank you!

Note: If you don’t currently know all of the answers and are accessing Form Estate - Small Estate Affidavit online, be sure to avoid closing the browser tab and potentially losing all your progress (or use a platform like Atticus to help avoid making mistakes).

Step 3 - Have Form witnessed or notarized (if required)

Some States and situations require particular forms to be notarized. If you have been instructed to get the document notarized or see it in writing on the document, then make sure to hire a local notary. There are max notary fees in the United States that are defined and set by local law. Take a look at our full guide to notary fees to make sure you aren’t overpaying or getting ripped off.

Step 4 - Submit Estate - Small Estate Affidavit to the relevant office

This is most often the local probate court where the decedent (person who passed away) is domiciled (permanently resides) or the institution involved with this particular form (e.g. a bank). Some offices allow you to submit forms online, other’s don’t, and we while we generally recommend going in-person to expedite the process, sometimes that simply isn’t an option.

It’s also a generally good idea to establish a positive working relationship with any probate clerk (unfortunately there’s enough people & process out there making things more difficult and unnecessarily confusing for them), so a best practice is to simply ask the probate clerk proactively exactly how and where they’d prefer you to submit all forms.

Need help getting in touch with a local probate court or identifying a domicile probate jurisdiction?

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Different probate forms or processes can require different deadlines or response times for completing the appropriate form.

While some steps in the process are bound to specific deadlines (like petitioning for probate, having to submit an inventory of assets, or filing applicable notices to creditors and beneficiaries), many probate forms or processes are not tied to a specific deadline since the scope of work can vary based on situational factors or requirements involved.

Either way, there are a bunch of practical reasons why personal representatives should work to complete each step as thoroughly and quickly as possible when completing probate in Tennessee.

5 reasons you should submit this form as quickly as possible:

1. The sooner you begin, the faster Tennessee can allow heirs and beneficiaries to get their share of assets subject to probate. Acting promptly can also decrease the costs & overall mental fatigue through an otherwise burdensome process.
   
   Helpful Context: What’s the Difference Between Probate and Non-Probate Assets?

2. In general, creditors of an estate usually have around 3-6 months from the time you file notice to creditors to file any claims for debt against the deceased’s assets. If they don’t, then that debt is forfeited (and more importantly, the executor won’t be held personally responsible). So doing this sooner means you have a better idea of who is owed what and ensures you won’t get a surprise collector months later.

3. Not filing a will within 30 days (on average) could mean that the probate process proceeds according to intestate laws (laws that govern what happens to someone's stuff without a will) or is subject to unnecessary supervision by the probate court. And if you aren't directly related to the deceased (a.k.a. next of kin), this could also mean you lose your inheritance.

4. It’s important to file any necessary state tax returns on behalf of the deceased or estate by the following tax season in Tennessee. If you don’t, you could owe penalties and interest. This also includes any necessary federal tax returns such as Forms 1040, 1041, or even a Form 706 estate tax return.

5. If a house in the State of Tennessee is left empty (or abandoned) for a while, insurance can get dicey. For example, if the house burns down and no one has been there for a year, an insurance company may get out of paying your claim.

If you’re not using Atticus to get specific forms, deadlines, and timelines for Tennessee probate, then try and stay as organized as possible, pay close attention to the dates mentioned in any correspondence you have with the State’s government officials, call the local Tennessee probate clerk or court for exact answers regarding Form Estate - Small Estate Affidavit, and when in doubt— consult a qualified trust & estates lawyer for that area.

Estate - Small Estate Affidavit is one of the many probate court forms available for download through Atticus.

It may also be available through some Tennessee probate court sites, such as . In order to access the latest version, be updated with any revisions, and get full instructions on how to complete each form, check out the Atticus Probate & Estate Settlement software or consider hiring a qualified legal expert locally within Tennessee.

While Atticus automatically provides the latest forms, be sure to choose the correct version of Form Estate - Small Estate Affidavit f using any other site or resource in order to avoid having to re-complete the form process and/or make another trip to the Tennessee probate court office.

Estate - Small Estate Affidavit is a .pdf, so opening it should be as simple as clicking “View Form” from within the Atticus app or by clicking the appropriate link found on any Tennessee-provided government platform. Once you’ve opened the form, you should be able to directly edit the form before saving or printing.

Here’s the text, verbatim, that is found on Tennessee Form Estate - Small Estate Affidavit. You can use this to get an idea of the context of the form and what type of information is needed.

SEVENTH CIRCUIT COURT FOR THE TWENTIETH JUDICIAL DISTRICT METROPOLITAN NASHVILLE / DAVIDSON COUNTY, TENNESSEE (EXCLUSIVE PROBATE JURISDICTION) SMALL ESTATE AFFIDAVIT This affidavit is to be used to file for an alternative small estate administration of your deceased’s (also known as “decedent”) estate pursuant to The Small Estates Act, T.C.A. § 30-4-101 et seq. FILING FEES FORMS REQUIRED ADDRESS OF PROBATE COURT CLERK’S OFFICE WITH WILL: $105.50 WITHOUT WILL: $100.50 CASH OR CASHIER’S CHECK ONLY!  Small Estate Affidavit.  Consents to Serve from ALL heirs (even if Will was left) in order to waive bond.  Consents to Serve from ALL beneficiaries (if Will left) in order to waive bond.  Original Will (if Will left).  Death Certificate (certified copy required). Davidson County Probate Court Clerk’s Office 1 Public Square, Room 303 Nashville, TN 37201 Requirements:  VALUE: Total value of all personal property owned by the deceased at death must be $50,000 or less. Personal property does not include real property (such as house or land).  RESIDENCE: The decedent must have resided in Davidson County when he or she died.  WAIT PERIOD: Forty-five (45) days must have passed since decedent’s death. If you need to access property prior to the end of 45 days, file a request in writing with the Court describing the reasons why expedited access is needed.  LAST WILL AND TESTAMENT: If a Last Will and Testament was left, you must file the original version with the Clerk. A Will is not probated under the Small Estate Act, but you must follow the instructions of the Will.  AUTHORITY TO FILE: In order to have authority to file this affidavit, you must be an heir at law (if no Will left) or either a beneficiary under the Will or the named personal representative (a/k/a Executor, Executrix) in the Will, or a creditor of the decedent proving the debt on oath before the Court, or have consents to serve from all heirs (if Will not left) or all beneficiaries or named personal representatives (if Will left).  NAME OF DECEASED (DECEDENT): You must state decedent’s full LEGAL NAME – not nickname.  NOTICE & BOND: Notice must be given of this action to all heirs at law and all beneficiaries in the Will. Bond may be set based on the value of the property unless you have consent forms sworn or signed under penalty of perjury from each heir at law (even if a Will was left) and each beneficiary. Note that minors and incompetent (i.e., mentally disabled) adults cannot give consent.  DATE OF HEARING: The Clerk will give you the court hearing date when you file the Affidavit. NOTE: The clerk’s office is authorized by T.C.A. § 30-4-103(1)(B) to assist you in completing this form but is prohibited from giving you legal advice. If you have any legal questions, consult an attorney. 02/01/2018 Small Estate Affidavit PAGE 1 OF 6 02/01/2018 SEVENTH CIRCUIT COURT FOR THE TWENTIETH JUDICIAL DISTRICT METROPOLITAN NASHVILLE / DAVIDSON COUNTY, TENNESSEE (PROBATE DIVISION) DOCKET #:_________________________ IN RE: ESTATE OF: ___________________________________________ PROBATE CLERK USE ONLY SMALL ESTATE ORDER SMALL ESTATE AFFIDAVIT FOR ASSET DISTRIBUTION (under authority of T.C.A. § 30-4-101 et. seq.) I, the undersigned Affiant, do hereby certify and declare the following is true and correct to the best of my belief, knowledge, and information: 1. My full legal name is _________________________________________________________________ . 2. My address is (city/state/zip) __________________________________________________________ . 3. My authority to file this Small Estate Affidavit is:  1. I am an heir at law to the deceased (“decedent”). My relationship to the decedent is: I am his/her _____________________________ .  2. I am a beneficiary or nominated Personal Representative (also called Executor, Executrix) in the decedent’s Last Will and Testament.  3. All those eligible under either #1 or #2 above have consented in writing for me to serve and I am filing those Consents with the clerk.  4. I am a sworn creditor and have provided evidence of the decedent’s debt.  5. I am filing on behalf of someone (you must attach the letter of authority that gives you that authority, such as a Power of Attorney). Please also check the box indicating why the person you are representing would have authority to serve. 4. The decedent’s full legal name was _____________________________________________________ . 5. The decedent died on the ____________ day of ____________________________, 20______. 6. The decedent died in the county of ____________________ in the state of ______________________ . 7. At the time of death, the decedent was _________ years old. 8. At the time of death, the decedent resided in the county of ____________________ in the state of __________________________. If outside the U.S., death was in ____________________________ . 9.  The decedent left a Last Will and Testament. I have deposited the Will with the Clerk and have filed a copy to support this Affidavit. I understand this Will is not probated but I am directed to follow the provisions in the Will.  The decedent did not leave a Last Will and Testament. Small Estate Affidavit PAGE 2 OF 6 02/01/2018 10. DEBTS OF THIS ESTATE  The decedent did NOT have any unpaid debts at the time of death.  Whether or not decedent had unpaid debts at the time of death is unknown.  The decedent left the following known debts that were unpaid at time of death (you may also include the funeral and burial debts): Creditor Creditor’s Address Amount of Debt $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID  If additional sheets are necessary to complete your list, please use the specified supplemental page included at the end of this form packet. 11. ASSETS OF THIS ESTATE  The decedent owned real property (house, land, etc).  The decedent did not own real property. ____________ By placing my initials here, I certify that the total value of the decedent’s personal property (not real property), as I’ve specifically listed on the next page, amounts to $50,000 or less. If I discover that the decedent’s assets were more than $50,000, I will file a Petition with the Court to convert this small estate administration to a full estate administration. ____________ By placing my initials here, I confirm that I understand that as Affiant of this Small Estate, I have no authority to claim, transfer, or distribute any assets owned by the decedent that are not listed on the next page. I understand I may amend this Affidavit if needed but will need a separate court order for it to be effective. You will list the assets on the next page. Small Estate Affidavit PAGE 3 OF 6 02/01/2018 The decedent owned the following items of personal property. I’ve included those items owned jointly, but not those items owned jointly with a right of survivorship or owned as tenancies by the entirety. I’ve included any life insurance policies payable to the deceased or his/her estate. # Type of Asset Description Amount Please list general category, such as Checking Account, Car, Household furnishings, etc. Please be specific... Include company name; account numbers; year, Make, Model and VIN numbers for vehicles; numbers identifying the instrument, check, or policy, etc, date of note, etc. The person or entity holding the asset may require it. If unknown, give best estimate. When estimated, write “Est.” before amount. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $  If additional sheets are necessary to complete your list, please use the specified supplemental page included at the end of this form packet. The assets listed above are possessed or under the control of these individuals or entities (if you are holding the asset, just check the box under “I Have The Asset” – no need to write your name and address): # From Above Table I Have The Asset Name of Other Person or Entity Who Has the Asset Address (if bank, just list the branch location) 1  2  3  4  5  6  7  Small Estate Affidavit PAGE 4 OF 6 02/01/2018 12. HEIRS AT LAW CERTIFICATION a) Did the decedent have a SPOUSE that was living at the time of decedent’s death? i.e. decedent got married and they never got a legal divorce  YES  NO b) Did the decedent have a CHILD, GRANDCHILD, GREAT GRANDCHILD, or GREAT-GREAT GRANDCHILD living at the time of decedent’s death? include adopted children but do NOT include step-children  YES  NO IF YOU CHECKED “YES”, WRITE THESE NAMES IN THE BOX ON THE NEXT PAGE: WRITE THE SPOUSE’S NAME IF YOU CHECKED “YES” TO (a) ABOVE; AND IF YOU CHECKED “YES” FOR (b), WRITE THESE NAMES: CHILDREN: list only if alive when decedent died. GRANDCHILDREN: list only if alive when decedent died AND that grandchild’s parent was a child of decedent who died before decedent. GREAT-GRANDCHILDREN: list only if alive when decedent died, AND 1) that great-grandchild’s parent was a grandchild of the decedent but died before decedent AND 2) that great-grandchild’s grandparent was a child of decedent but died before decedent. (If a great-grandchild would have been an heir but died before decedent, that person’s children would be heirs if living when decedent died, and so-on.) THESE WILL BE THE ONLY HEIRS AT LAW - DO NOT CONTINUE ON THIS PAGE. IF YOU CHECKED “NO” IN BOTH BOXES ABOVE: c) Did the decedent have a PARENT living at the time of his/her death?  YES  NO IF YOU CHECKED “YES,” WRITE THE NAMES OF THE PARENTS LIVING AT THE TIME OF DECEDENT’S DEATH IN THE BOX ON THE NEXT PAGE. THESE WILL BE THE ONLY HEIRS AT LAW - DO NOT CONTINUE ON THIS PAGE. IF YOU CHECKED “NO” IN ALL BOXES ABOVE: d) Did the decedent have a SIBLING (BROTHER/SISTER), or a descendant of the sibling (NIECES/NEPHEWS, GREAT-NIECES/GREAT-NEPHEWS, ETC.) living at the time of his/her death?  YES  NO IF YOU CHECKED “YES”, WRITE THESE NAMES IN THE BOX ON THE NEXT PAGE: BROTHER OR SISTER: list only if alive when decedent died. A NIECE OR NEPHEW: list only if alive when decedent died AND that niece/nephew’s parent was a brother or sister of decedent and died before decedent. GREAT-NIECE/GREAT-NEPHEW: list only if alive when decedent died, AND 1) that great-niece/nephew’s parent was a niece or nephew of the decedent but died before decedent AND 2) that great-niece/nephew’s grandparent was a brother or sister of decedent but died before decedent . (if a great-niece/nephew would have been an heir but died before decedent, that person’s children would be heirs if living when decedent died, and so-on.) THESE WILL BE THE ONLY HEIRS AT LAW. Small Estate Affidavit PAGE 5 OF 6 02/01/2018 IF YOU CHECKED “NO” IN ALL BOXES ON THE LAST PAGE: e) Did the decedent have a MATERNAL GRANDPARENT (mother’s side of the family) living at the time of his/her death?  YES  NO f) Did the decedent have a PATERNAL GRANDPARENT (father’s side of the family) living at the time of his/her death?  YES  NO STEP ONE: IF YOU CHECKED “YES” TO BOTH: WRITE THE GRANDPARENTS’ NAMES LIVING WHEN DECEDENT DIED IN THE BOX BELOW. THOSE ARE THE ONLY HEIRS AT LAW. GO TO NEXT PAGE. IF YOU CHECKED “YES” TO ONE AND “NO” IN THE OTHER ONE: WRITE THE NAME(S) OF THE LIVING GRANDPARENT(S) AT DECEDENT’S DEATH IN THE BOX BELOW AND PROCEED TO STEP TWO BELOW. IF YOU CHECKED “NO” TO BOTH, PROCEED TO STEP TWO BELOW. STEP TWO: WRITE THESE NAMES IN THE BOX BELOW ONLY IF ALL BOXES ON PRECEEDING PAGE WHERE CHECKED “NO” AND AT LEAST ONE BOX ABOVE IS CHECKED “NO”: AUNT OR UNCLE: list only if alive when decedent died AND both parents of that aunt or uncle died before decedent. COUSIN: list only if alive when decedent died AND 1) that cousin’s parent was an aunt or uncle of the decedent but died before decedent and 2) that cousin’s grandparents were also grandparents of the decedent and BOTH died before decedent. (if a cousin would have been an heir but died before decedent, that person’s children would be heirs if living when decedent died, and so-on.) 13. THE HEIRS AT LAW Name Mailing Address Relationship to Decedent Current Status  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  If additional sheets are necessary to complete your list, please use the specified supplemental page included at the end of this form packet. Small Estate Affidavit PAGE 6 OF 6 02/01/2018 14. BENEFICIARIES OF THE WILL If a Will was left, list those names that were left property in the Will. Name Mailing Address Relationship to Decedent Current Status  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  If additional sheets are necessary to complete your list, please use the specified supplemental page included at the end of this form packet. 15. OATH I AFFIRM THAT EVERYTHING ON THIS AFFIDAVIT IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND I MAY BE SUBJECT TO THE PENALTY OF PERJURY FOR A FALSE OR MISLEADING AFFIDAVIT. I AM WILLING TO COLLECT AND PRESERVE ALL ASSETS, PAY ALL CREDITORS, AND DISTRIBUTE AS PROVIDED BY THE WILL , OR, IF THERE IS NO WILL, BY THE LAWS OF DESCENT AND DISTRIBUTION PURSUANT TO T.C.A. § 30-4-101 et seq. YOUR SIGNATURE: X PHONE #: STATE OF TENNESSEE COUNTY OF DAVIDSON Personally appeared before me, Notary Public/Deputy Clerk, the said ___________________________________________________________________, and after being sworn, deposes and says, subject to the penalty of perjury, that the Affidavit is not false or misleading and that the Affiant is mindful of all duties imposed upon her or him. SWORN AND SUBSCRIBED BEFORE ME, THIS _______ DAY OF _____________, 20___. NOTARY PUBLIC/ DEPUTY CLERK X COMMISSION EXPIRES: Small Estate Affidavit SUPPLEMENTAL PAGE 02/01/2018 DEBTS OF THIS ESTATE (ADDITIONS TO PAGE 2 OF AFFIDAVIT) Creditor Creditor’s Address Amount of Debt $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID $  NOW PAID  This list is continued on another sheet I’ve attached. Small Estate Affidavit SUPPLEMENTAL PAGE 02/01/2018 ASSETS OF THIS ESTATE (ADDITIONS TO PAGE 3 OF AFFIDAVIT) # Type of Asset Description Amount Please list general category, such as Checking Account, Car, Household furnishings, etc. Please be specific... Include company name; account numbers; year, Make, Model and VIN numbers for vehicles; numbers identifying the instrument, check, or policy, etc, date of note, etc. The person or entity holding the asset may require it. If unknown, give best estimate. If estimated, write “Est.” before amount. 8 $ 9 $ 10 $ 11 $ 12 $ 13 $ 14 $ 15 $  This list is continued on another sheet I’ve attached. # From Above Table I Have The Asset Name of Other Person or Entity Who Has the Asset Address (if bank, just list branch location) 8  9  10  11  12  13  14  15  Small Estate Affidavit SUPPLEMENTAL PAGE 02/01/2018 ASSETS OF THIS ESTATE (ADDITIONS TO PAGE 3 OF AFFIDAVIT) # Type of Asset Description Amount Please list general category, such as Checking Account, Car, Household furnishings, etc. Please be specific... Include company name; account numbers; year, Make, Model and VIN numbers for vehicles; numbers identifying the instrument, check, or policy, etc, date of note, etc. The person or entity holding the asset may require it. If unknown, give best estimate. If estimated, write “Est.” before amount. 16 $ 17 $ 18 $ 19 $ 20 $ 21 $ 22 $ 23 $  This list is continued on another sheet I’ve attached. # From Above Table I Have The Asset Name of Other Person or Entity Who Has the Asset Address (if bank, just list branch location) 16  17  18  19  20  21  22  23  Small Estate Affidavit SUPPLEMENTAL PAGE 02/01/2018 ASSETS OF THIS ESTATE (ADDITIONS TO PAGE 3 OF AFFIDAVIT) # Type of Asset Description Amount Please list general category, such as Checking Account, Car, Household furnishings, etc. Please be specific... Include company name; account numbers; year, Make, Model and VIN numbers for vehicles; numbers identifying the instrument, check, or policy, etc, date of note, etc. The person or entity holding the asset may require it. If unknown, give best estimate. If estimated, write “Est.” before amount. 24 $ 25 $ 26 $ 27 $ 28 $ 29 $ 30 $ 31 $  This list is continued on another sheet I’ve attached. # From Above Table I Have The Asset Name of Other Person or Entity Who Has the Asset Address (if bank, just list branch location) 24  25  26  27  28  29  30  31  Small Estate Affidavit SUPPLEMENTAL PAGE 02/01/2018 THE HEIRS AT LAW (ADDITIONS TO PAGE 5 OF AFFIDAVIT) Name Mailing Address Relationship to Decedent Current Status  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  This list is continued on another sheet I’ve attached. Small Estate Affidavit SUPPLEMENTAL PAGE 02/01/2018 BENEFICIARIES OF THE WILL (ADDITIONS TO PAGE 6 OF AFFIDAVIT) Name Mailing Address Relationship to Decedent Current Status  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  UNDER 18  NOW DECEASED  This list is continued on another sheet I’ve attached. Small Estate Affidavit Consent to Serve Without Bond 02 /01/2018 In the Circuit Court of Davidson County, Tennessee (Probate Division) CONSENT TO SERVE WITHOUT BOND ▪▪▪▪▪▪▪▪▪▪ SMALL ESTATE IN THE ESTATE OF: DOCKET NO: Deceased I, , beneficiary of the above- referenced estate, do hereby waive my appointment as the Personal Representative/Affiant of this estate and consent to the appointment of as Personal Representative/Affiant of the estate, as evidenced by my signature below, whether notarized or signed under penalty of perjury, and I further state to the Court that this appointment shall be without Surety Bond. This day of , 20 . PRINT NAME: ADDRESS: Signature State of County of Sworn to and subscribed before me, this day of , 20 . Notary Public / Deputy Clerk My Commission Expires: OR I certify under penalty of perjury that the foregoing is true and correct. Signature