4B-601

STATE OF NEW MEXICO

IN THE PROBATE COURT

_______________ COUNTY

                                                                                                            No. _________

IN THE MATTER OF THE ESTATE OF

______________________, DECEASED.

AFFIDAVIT OF POVERTY AND INDIGENCY

I, the applicant, state upon my oath that:

A.        I wish to start an action in the Probate Court of ____________ County, New Mexico;

B.        I do not have the money to pay the costs of the action;

C.        The estate does not have enough funds to pay the costs of the action because the estate only has the following assets (list assets):

____________________________________________________________________

________________________________________________________________.

WHEREFORE, I ask that I not have to pay the costs of this action, including the filing fee.

________________________________

Signature of applicant

________________________________

Printed name

________________________________

Street address

________________________________

City, state and zip code

________________________________

Telephone number

STATE OF NEW MEXICO              )

)ss.

COUNTY OF _________________  )

I, ____________________________, am the applicant. I state, upon oath, that the affidavit, and the statements in it, are true and correct as far as I know and believe.

__________________________________

Signature of applicant

SIGNED AND SWORN TO before me this ____ day of ________________, ____ by __________________.

___________________________

Notary Public

(Seal)                                                  My commission expires: ____________