How do I complete this debt-payment affidavit?

Fill in the decedent’s information, your relationship, the people entitled to payment, and the statements requested. Sign the affidavit before a notary, then submit it to the Office of the Lieutenant Governor division shown on the form.

Do I need to sign the affidavit in front of a notary?

Yes. The form includes a “Subscribed and Sworn to before me” jurat, so the claimant signs before a notary who completes the notarial portion.

Can I use an online notary for this form?

The form requires notarization but does not say whether remote online notarization is accepted. Territory rules recognize certain notarial acts performed elsewhere, but whether that includes an online notarization is not confirmed here. Confirm with the receiving agency or the Recorder of Deeds if unsure.

What payment amount does the affidavit mention?

The form asks the claimant to state that payments by all debtors, known after diligent inquiry, do not exceed $10,000 as provided by regulation.

Office of the Lieutenant Governor, VI · St. Thomas

Affidavit Payment of Certain Debts Without Administration

This affidavit lets a claimant provide information about a deceased person and certain payments when seeking payment of debts without administration through the Office of the Lieutenant Governor’s Division of Banking, Insurance and Financial Regulation.

Simple form~10 min to notarize

licensed online notary
~15 min average
Notarized PDF emailed

What you’ll need

Government-issued photo ID
Webcam-enabled device (laptop or phone)
This form, ready to upload as a PDF

Form previewView full PDF →

What this form is

The affidavit collects the decedent’s name and date of death, the claimant’s relationship, information about people entitled to receive payment, and statements about whether an executor or administrator has been appointed. The claimant also states that known payments, after diligent inquiry, do not exceed the $10,000 amount described on the form. The form cites Section 89, Title 15 of the Virgin Islands Code and includes a sworn-signature block.

Who needs it

A claimant seeking payment of certain debts without administration uses this affidavit to provide the decedent, claimant, recipient, and payment information requested on the form.

Why it needs a notary

The form has a “Subscribed and Sworn to before me” jurat; the claimant signs the affidavit before a notary, who completes the date and notary details.

How to get this notarized

1
Download the Affidavit
Get the one-page affidavit for payment of certain debts without administration.
2
Complete the Requested Details
Enter the decedent’s information, your relationship, recipient details, and the required statements.
3
Book an Online Notary
Arrange a session with a commissioned online notary and confirm the receiving agency accepts remote notarization.
4
Sign During the Video Session
Sign the affidavit before the notary so the notary can complete the jurat.
5
Submit to the Agency
Send the completed affidavit to the appropriate Office of the Lieutenant Governor division.

Preview the form

The blank PDF straight from Office of the Lieutenant Governor. Look it over, then upload your filled copy to start the notary session.

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You’ll need ID and a webcam.

A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.