Use our online forms to help draft your own Small Estate Affidavit personalized with your own state, county or parish information. Do it yourself and save money with our free Small Estate Affidavit template. It takes only 5 minutes to fill out and the form is completely online.
The example below is a sample of a Small Estate Affidavit that can be used as a reference when conducting research on filling out your affidavit:
Sample Affidavit of Small Estate Form
SMALL ESTATE AFFIDAVIT
[ to be used only when decedent died
on or after September 4, 1991.]
I, , on oath state:
(name of affiant)
1. ( a ) My post office address is:__________________________________________________
( b ) My residence address is:___________________________________________________
( c ) I understand that, if I am an out-of-state resident, I submit myself to the
jurisdiction of ___________ courts for all matters related to the preparation and use of this
affidavit. My agent for service of process in ______________ is:
Name_________________________________________
Address_______________________________________
City___________________________________________
Telephone (if any)______________________________
I understand that if no person is named above as my agent for service or, if for any
reason, service on the named person cannot be effectuated, the Clerk of the Circuit Court
of ______________________________ (county)___________________ is recognized
by _______________ law as my agent for service of process.
2. The decedent’s name is ___________________________________________________
3. The date of the decedent’s death was________________________, and I
have attached a copy of the death certificate hereto.
4. The decedent’s place of residence immediately before his death was_________
_______________________________________________________________________________________
5. No letters of office are now outstanding on the decedent’s estate and no
petition for letters is contemplated or pending in _____________________ or in any other jurisdiction,
to my knowledge.
6. The gross value of the decedent’s entire personal estate, including the value
of all property passing to any party either by intestacy or under a will, does not exceed
$_______________. (here, list each asset, e.g. cash, stock and its fair market value.)
Page 1 of 47. ( a ) All of the decedent’s funeral expenses have been paid, or
( b ) The amount of the decedent’s unpaid funeral expenses and the name and post
office address of each person entitled thereto are as follows:
7. Name and post office address Amount
8. There is no known unpaid claimant or contested claim against the decedent,
except as stated in paragraph 7.
9. ( a ) The names and places of residence of any surviving spouse, minor children and
adult dependent children* of the decedent are as follows:
Name and Place of Age of
Relationship Residence Minor Child
( b ) The award allowable to the surviving spouse of a decedent who was an ________________
resident is $___________________ ($_________, plus $________ multiplied by the number of minor
children and adult dependent children who resided with the surviving spouse at the time of
the decedent’s death. If any such child did not reside with the surviving spouse at the
time of the decent’s death, so indicate).
( c ) If there is no surviving spouse, the award allowable to minor children and
adult dependent children of a decedent who was an ______________ resident is $________________
($______, plus $_______ multiplied by the number of minor children and adult dependent
children), to be divided among them in equal shares.
( a ) The decedent left no will. The names, places of residence and relationship of
the decedent’s heirs, and the portion of the estate to which eash heir is entitled under
the law where decedent died intestate are as follows:
Name, relationship Age of Portion of
and place of residence Minor estate
(or)
( b ) The decedent left a will, which has been filed with the clerk of an
appropriate court. A certified copy of the will on file is attached. To the best of my
knowledge and belief the will on file is the decedent’s last will and was signed by the
decedent and the attesting witnesses as required by law and would be admissable to
probate. The names and places of residence of the legatees and the portion of the estate,
if any, to which each legatee is entitled are as follows:
Name, relationship Age of Portion of
and place of residence Minor estate
( c ) Affiant is unaware of any dispute or potential conflict as to heirship or
will of the decedent.
Page 3 of 411. The property described in paragraph 6 of this affidavit would be distributed
as follows:
Specific sum or property
Name to be distributed
The foregoing statement is made under the penalties of perjury.*
_______________________________________________
Signature of affiant
*(Note: A FRAUDULENT STATEMENT MADE UNDER THE PENALTIES OF PERJURY IS PERJURY, AS DEFINED
IN THE SECTION ______________________.)
Name________________________________________________________________________________________
Business Address____________________________________________________________________________
City, State, Zip Code_____________________________________________________