Washington Notice of Escheat Estate

Notice of Escheat Estate
Notice of Escheat Estate
Title of Form

This form is required to be completed and submitted to the Department of
Revenue when someone dies under the jurisdiction of Washington state without
a will or known heirs. Complete this form to the best of your knowledge. Use
additional sheets if necessary. Documentation supporting value is requested. If
documentation is unavailable, you may use estimates if identified as such.

Form 85 0030
Audit Division
PO Box 47474
Olympia WA, 98504-7474

Decedent’s name
First:

Reset form

Notice of Escheat Estate

Middle:

Last:

Social Security number:

Last known street address and city:
State:

Zip code:

Informant’s name
First:

Date of death:
Middle:

Last:

Mailing address:
City:
Phone:

State:

Zip code:

Email:

Assets List type (bank accounts, cash, stocks, bonds, real property, personal effects, vehicles, collections, home
furnishings, jewelry, other) and value:
Brief description of asset

Value of items

Debts List type (funeral costs, medical bills, credit card debt, mortgages, car loans, other) and amount:
Brief description of asset

Value of items

Relationship Describe your relationship to the decedent and whether you are a creditor of the decedent’s estate:

Under the provisions of RCW 11.28.120(5)(a), the director of revenue, or the director’s designee, has the right to
serve as personal representative of an escheat estate. The director may waive this right. The department must
acknowledge receipt of this form in order for the probate of an escheat estate to
proceed. If the department is not timely notified the probate may be voided per RCW
Print form
11.08.170 Probate of escheat property – Notice to Department of Revenue.

To ask about the availability of this publication in an alternate format for the visually impaired, please call
360-705-6705. Teletype (TTY) users may use the WA Relay Service by calling 711.
REV 85 0030 (1/26/21)				

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