For value received, I, _________________, of ______________, assign to _______________, of ___________________, as assignee, all my right, title, and interest in the estate of ________________, deceased, whose last place of residence was _______________, and who died on _____________, 19___.

I warrant that the value of property due me is at least __________ Dollars ($_________), and I agree to execute on demand any and all documents necessary or convenient to transfer to assignee all of the interest in either the real or personal property of descendant to which I am entitled by virtue of the death.

This assignment is made subject to and on condition that assignee pay all estate and inheritance taxes which would have been payable by assignor with respect to the estate.

Dated _____________, 19___.

__________________________

STATE OF __________________

COUNTY OF _________________

BEFORE ME, the undersigned authority, on this __ day of ___________, 19__, personally appeared _____________ to me well known to be the person described in and who signed the Foregoing, and acknowledged to me that he executed the same freely and voluntarily for the uses and purposes therein expressed.

WITNESS my hand and official seal the date aforesaid.

___________________________
NOTARY PUBLIC

My Commission Expires:_____