O.C.G.A. § 7-1-239

(1) As used in this Code section, the term: “Affidavit of the provider” means the form provided for in subsection (e) of this Code section.

(2) “Financial institution” means any federally chartered financial institution or state chartered financial institution, including, but not limited to, those chartered by states other than the State of Georgia whose deposits are federally insured.

(9) The protection provided by paragraph (1) of this subsection does not extend to payments made after a financial institution has received: Written notification sent by any party able to request present payment or the legal representative of any such party to the registered agent of the financial institution by registered or certified mail, return receipt requested, or statutory overnight delivery, expressly stating that payments in accordance with the provisions of this Code section should not be permitted; or

(10) Service of notice upon the registered agent of the financial institution of a proceeding in the probate court in the estate of the deceased depositor in accordance with Chapter 11 of Title 53; provided, however, that, if any payment is made pursuant to subsection (c) of this Code section by an employee of the financial institution who is without actual knowledge of such written notification or service of notice within three business days following the receipt of such written notification or service of notice by the registered agent of the financial institution, the protection provided by paragraph (1) of this subsection shall extend to any such payment.

(11) A financial institution that is asked to apply funds from the deposit of a deceased depositor as requested in an affidavit of the provider may, without risk of incurring any penalty or liability to any person: Rely on the written notification or service of notice provided by paragraph (2) of this subsection in refusing to disburse the funds as requested in the affidavit of the provider;

(12) Delay disbursement of the funds as requested in the affidavit of the provider for up to 180 days following the receipt by the financial institution of such affidavit of the provider; and

(13) Decline to disburse funds from the deposit of the deceased depositor except as authorized or directed in an order entered by the probate court having jurisdiction over the estate of the deceased depositor.

(14) Notwithstanding subsection (c) of this Code section or any other provision of this subsection, payments made pursuant to an order entered by the probate court having jurisdiction over the estate of a deceased depositor shall operate as a complete acquittal and discharge to the financial institution of liability from any suit, claim, or demand of whatever nature by any heir, distributee, or creditor of the decedent, or any other person.

(15) Nothing in this subsection shall relieve the liability of or limit the availability of any remedies against any provider of services giving an affidavit in the form provided for in subsection (e) of this Code section for any violation of Code Section 16-10-71, Code Section 53-6-2, or other applicable law.

(16) A document substantially in the following form shall be used as the affidavit of the providers of services of funeral expenses and expenses of last illnesses of deceased depositors: “State of Georgia County of _______________ _______________ from _______________ attests that (Claimant) (Facility) _______________ died on the _______________ day of _______________, 20 _______________. (Deceased) On information and belief, the Deceased has funds on deposit with _______________. (Financial Institution) Under O.C.G.A. § 7-1-239, such Financial Institution is authorized to pay the proceeds of the Deceased’s deposits, but in no event more than $15,000.00, directly to the following persons identified, collectively, as potential recipient(s): To the surviving spouse;

(17) If no surviving spouse, to the children pro rata;

(18) If no children or surviving spouse, to the father and mother pro rata; or

(19) If none of the above, then to the brothers and sisters of the decedent pro rata. _______________ Signature of Claimant Sworn and subscribed before me this _______________ day of _______________, 20 _______________. Notary public (SEAL) My commission expires: _______________.” Except as provided for by Article 8 in Title 7 of the O.C.G.A., if no request for the Deceased’s deposit is made by a potential recipient(s) within 45 days from the Deceased’s death, the Financial Institution is authorized to release up to $15,000.00 for funeral expenses and expenses of the last illness of the Deceased upon the receipt of itemized statements of such expenses and this executed attestation. The Claimant attests that there is no known will of the Deceased and there is no known potential recipient of the Deceased’s deposits. The Claimant also attests that funeral expenses or expenses of the last illness in the amount of $ _______________ were incurred related to the Deceased and that true and correct copies of the itemized receipts fully supporting such amount are attached to this affidavit. Finally, the Claimant further attests that such expenses have not been paid as of the date of execution of this affidavit. Pursuant to O.C.G.A. § 7-1-239, the Claimant submits this form in order to receive payment in the amount of $ _______________ (shall not exceed $15,000.00) for outstanding funeral expenses or expenses of the last illness of the Deceased.

STATUTORY AFFIDAVIT FORM