For value received, I, _______(1)__________, of _______(2)_______, assign to _______(3)________, of _________(4)__________, as assignee, all my right, title, and interest in the estate of _______(5)_________, deceased, whose last place of residence was _______(6)________, and who died on ______(7)_______, 19__(8)_.

I warrant that the value of property due me is at least _____(9)_____ 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 _____(10)________, 19__(11)_.

____________(12)______________

STATE OF ________(13)__________

COUNTY OF _______(14)__________

BEFORE ME, the undersigned authority, on this _(15)_ day of _____(16)______, 19_(17)_, personally appeared ______(18)_______ 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.

______________(19)_____________

NOTARY PUBLIC

My Commission Expires:___(20)__