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Form 411088
06-11

AFFIDAVIT OF DEATH INTESTATE
IN RE TRANSFER OF MOTOR VEHICLE, PROPERTY OF THE ESTATE OF:

Name of Decedent

AFFIDAVIT

State of Iowa
County
Now on this

}

ss.

day of

,

; the undersigned,
Year

being first duly sworn on oath depose and state that the decedent above named died intestate on the
day of
,
; and that there has been no
Year

administration of said decedent's estate; that at the time of death the said decedent owned and
possessed the following described vehicle:
Make

Model

Color

Style

Year

V.I.N. #

Title No.

Year
License No.

That the said motor vehicle was titled and licensed in the said decedent's name; that under the laws of
descent and distribution of the State of Iowa the undersigned are/is entitled to the possession and
ownership of the said motor vehicle, that the undersigned hereby agrees to indemnify any creditors of the
decedent who would be entitled to levy execution upon said motor vehicle to the extent of the value of
said motor vehic