Use the form with the boxes to guide you through filling out the blank form. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge and belief.Box 1: Print the name of the county in which you filed. A pennsylvania small state affidavit petitions the orphans court for appointments as the personal representative over a deceased person's small estate. State each fact in a separate paragraph. A sample affidavit that may be used in Pennsylvania state civil litigation. General Form of Affidavit or Verification 1.4.1. This Affidavit must be filed within 90 days of the original complaint filing date. Use the form with the arrowboxes to guide you through filling out the blank form. 1. The numbers on these instructions correspond with the numbers in the boxes on the form.