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AFFIDAVIT OF DEATH INTESTATE
IN RE TRANSFER OF MOTOR VEHICLE, PROPERTY OF THE ESTATE OF:
State of Iowa
Now on thisday of, ; the undersigned,
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
administration of said decedent's estate; that at the time of death the said decedent owned and
possessed the following described vehicle:
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 vehicle, and further agree to indemnify and save harmless the said County Treasurer of
County, Iowa, from any damages sustained by any person or
persons, because of such assignment.
Notary Public in and for County,
State of Iowa
DISCLOSURE STATEMENT: The information furnished on this form will be used by the Department of Transportation and the
county treasurer's office to transfer ownership of a vehicle to a deceased person's heirs. All information is required. Failure to
complete the form would mean a denial to transfer the vehicle.
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