AFFIDAVIT OF LOST INSTRUMENT
GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING, INSURANCE AND FINANCIAL REGULATION 5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: 340-774-7166 • Fax: 340-774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: 340-773-6459 • Fax: 340-719-3801 AFFIDAVIT PAYMENT OF CERTAIN DEBTS WITHOUT ADMINISTRATION Pursuant to Section 89, Title 15 of the Virgin Islands Code I/WE, ___________________________________, after being first duly sworn, depose and state that: 1. Name of the decedent: _________________________________________________ 2. The date of death of the decedent: _________________________________________ 3. The relationship of the affiant to the decedent: ______________________________ 4. That no executor or administrator has qualified or been appointed; 5. …
Download the original document · Plain text (TXT) · Browse the archive · How this archive works
Original source: https://web.archive.org/web/20240801004331id_/https://ltg.gov.vi/wp-content/uploads/2024/07/AFFIDAVIT-settlement-without-administration-002.pdf
SHA-256 94d0bbeb5bfbf7c2a385efeb986f78f41ad048fd5959e6a9ae2578066ecfd3a1
Re-using this document
A public record of the Government of the Virgin Islands, published by the agency itself. No copyright is asserted on it and 17 U.S.C. § 105 does not reach territorial government, so it publishes as a territorial public record.
Our description, tagging, arrangement, extracted text and machine transcripts are released under CC0 1.0. We assert nothing about the document itself.
Archive identifier LF-94d0bbeb5bfb
Document text
GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING, INSURANCE AND FINANCIAL REGULATION 5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: 340-774-7166 • Fax: 340-774-9458 1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: 340-773-6459 • Fax: 340-719-3801 AFFIDAVIT PAYMENT OF CERTAIN DEBTS WITHOUT ADMINISTRATION Pursuant to Section 89, Title 15 of the Virgin Islands Code I/WE, ___________________________________, after being first duly sworn, depose and state that: 1. Name of the decedent: _________________________________________________ 2. The date of death of the decedent: _________________________________________ 3. The relationship of the affiant to the decedent: ______________________________ 4. That no executor or administrator has qualified or been appointed; 5. The names and addresses of the persons entitled to and who will receive the money paid; and Name:___________________________ Name:______________________________ Address: _________________________ Address: ____________________________ _________________________ ____________________________ _________________________ ____________________________ 6. That such payment and all other payments made, by all debtors, known to the affiant, after diligent inquiry, do not in the aggregate exceed such amount of $10,000 as provided by regulation promulgated by the Lieutenant Governor of the Virgin Islands. ___________________________________ Date: ________________________ Claimant’s Signature Subscribed and Sworn to before me this _____ day of _____________________, 20______. ____________________________________ Notary Public NP#__________________ Expires:_______________