IN THE OFFICE OF THE CLERK OF JUDICIAL RECORDS

OF LEHIGH COUNTY, PENNSYLVANIA

REGISTER OF WILLS DIVISION

In re: Estate of	File No.
Deceased	Social Security No.

AFFIDAVIT OF FOREIGN FIDUCIARY

being duly sworn, depose and say as follows:

I am	Executor

We are	Administrator

Trustee

Guardian in the above estate.

Decedent died	a resident of
Date
City
County
State

That deponent(s) desire(s) to exercise within the Commonwealth of Pennsylvania the authority vested in deponent(s) by virtue of an Act of Assembly of the Commonwealth of Pennsylvania, known as the Probate, Estates and Fiduciaries Code of 1972, P.L. 164, Section 4101 (1) and (2), and has complied with all the provisions of same.

That after diligent search and inquiry, deponent(s) state(s) that so far as deponent(s) has/have been able to discover, the above Decedent is not indebted to any person in the Commonwealth of Pennsylvania; and that deponent(s) will not exercise any power which deponent(s) would not be permitted to exercise in the jurisdiction of deponent’s(s’) appointment.

Sworn to or affirmed and subscribed before me this

day of	, 20

Notary Public

My Commission Expires:

(Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary’s commission.)

(Signature)
(Address)
(Signature)
(Address)
Note: Do not file this affidavit until after one month from Decedent’s death. An exemplified copy of probate proceedings must accompany this form.

Rev 7/12

Register of Will of Lehigh County, Pennsylvania

Rachel A Wotring

2012-08-20

Lehigh County