Form 7 - REQUEST FOR REDEMPTION OF CAPITAL WITH RESPECT TO A DECEDENT

REQUEST FOR REDEMPTION OF CAPITAL WITH RESPECT TO A DECEDENT

To: Central Prairie Co-op, Sterling, KS 67579

You are hereby requested to retire and pay to the undersigned any and all capital credited to the decedent named below. We do hereby acknowledge that said capital will be paid to the undersigned pursuant to the policy for payment established by the Board of Directors, and do hereby consent to the distributive shares* stated below. AFFIDAVIT OF HEIRSHIP
Trustee or Executor
of lawful age, being first duly sworn upon his/her oath, deposes and states
(1) That
(name of decedent) died at
(place) on the
day of
20
that at the time of death, decedent was a resident of
county, state of
and a member of Central Prairie Co-op, KS.
(2) That the decedent was survived by the following named persons who are the sole heirs
Name and Relationship
Address
% Share*
(3) That the decedent had no spouse or children or adopted children or issue of deceased children, natural or adopted, who survived the decedent, other than the persons above named.
(4) That all of the debts of the decedent have been paid in full, and the Affiant agrees to defend, indemnify and hold harmless Central Prairie Co-op from any and all claims which may be made to or against said capital (for which retirement is requested) by any party not named above.
(5) That Affiant has read the foregoing Request for Redemption of Capital and that the statements contained therein are, to the best of Affiant’s knowledge and belief, true and correct.
Affiant
*Share: Indicates the share or proportion of the capital credit to the above named decedent which should be paid (upon redemption) to each heir
State of
County of
Subscribed and sworn to before me this
day of
20
Notary Public
(Seal) My commission expires
20

REQUEST FOR REDEMPTION OF CAPITAL WITH RESPECT TO A DECEDENT

(2) That the decedent was survived by the following named persons who are the sole heirs

(3) That the decedent had no spouse or children or adopted children or issue of deceased children, natural or adopted, who survived the decedent, other than the persons above named.

(4) That all of the debts of the decedent have been paid in full, and the Affiant agrees to defend, indemnify and hold harmless Central Prairie Co-op from any and all claims which may be made to or against said capital (for which retirement is requested) by any party not named above.

(5) That Affiant has read the foregoing Request for Redemption of Capital and that the statements contained therein are, to the best of Affiant’s knowledge and belief, true and correct.

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