Estate Affidavit

SMALL ESTATE AFFIDAVIT
AFFIDAVIT FOR THE COLLECTION OF PROPERTY

County of __________________ )
State of __________________ ) ss.
1. THE DECEDENT. This Small Estate Affidavit (“Affidavit”) made on

__________________, 20____ acts as a petition regarding the estate of:
Decedent: __________________, who died on __________________,

20____ in the county of __________________, state of
__________________ (“Decedent”).
A copy of the Decedent’s death certificate shall be submitted along with this
Affidavit.
2. THE AFFIANT. The name of the person preparing this Affidavit is

__________________ with a mailing address of
____________________________________ (“Affiant”).
3. DAYS AFTER DEATH. The Decedent died on the Date mentioned in Section 1,
which is more than the statutory limit of ____ days required to file this Affidavit.
4. STATUTORY AMOUNT. The estimated value of the Decedent’s estate does not
exceed the monetary limit of $__________________ imposed by the state of
__________________.
5. PROPERTY AND ASSETS. The property and assets of the Decedent’s estate
are as follows:
Description Value ($)

______________________________________ $_______________
______________________________________ $_______________
______________________________________ $_______________
______________________________________ $_______________
______________________________________ $_______________
6. DEBTS AND LIABILITIES. The debts and liabilities of the Decedent’s estate are
as follows:
Description Value ($)

______________________________________ $_______________
______________________________________ $_______________
______________________________________ $_______________
______________________________________ $_______________
______________________________________ $_______________
7. THE HEIRS. All heirs, devisees, or possible beneficiaries of the Decedent are
listed below:
Heir’s Name: __________________ Relationship: __________________

Address: ____________________________________
Phone: __________________ E-Mail: ____________________________

Address: ____________________________________
Phone: __________________ E-Mail: ____________________________

Address: ____________________________________
Phone: __________________ E-Mail: ____________________________
Hereinafter known as the “Heirs” and shall be given notice of this Affidavit within
30 days of filing with the court.
8. TRANSFER OF PROPERTY. The following Heirs are entitled to the following

property:
Property Heir’s Name

______________________________________ _______________
______________________________________ _______________
______________________________________ _______________
______________________________________ _______________
______________________________________ _______________
9. OFFICIAL STATEMENT. I, the Affiant, declare under penalty of perjury under the
laws of the state of Governing Law that the information I have provided in this
Affidavit are true and correct.
a. Pending Administration. There is no pending administration of the
Decedent’s estate.
b. Probate. There is no reasonable expectation that probate of the
Decedent’s estate is soon or ever shall commence.
c. Governing Law. This Affidavit is governed under the laws located in the
state of __________________.
10. EXECUTION. This Affidavit is required to be signed under the requirements of

state law which may require a notary public, two (2) disinterested witnesses, or
both.
Affiant’s Signature: ___________________________ Date: _______________
Print Name: ___________________________

NOTARY ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached, and not
the truthfulness, accuracy, or validity of that document.
County of ___________________________ )
State of ___________________________ ) ss.
On, ___________________________, 20____ before me,

___________________________ (name and title of officer), personally appeared
___________________________, who proved to me on the basis of satisfactory
evidence to be the person whose name is subscribed to the within instrument and
acknowledged to me that they executed the same in their authorized capacities, and
that by their signature on the instrument the person, or the entity upon behalf of which
the person acted, executed the instrument.
I certify under the PENALTY OF PERJURY under the laws of the governing state that
the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature: ___________________________
Print Name: ___________________________
(seal)
WITNESS ACKNOWLEDGMENT
WITNESS 1
I, ___________________________, have no interest in the estate nor am I related to

the Decedent deceased. The statements made in this Affidavit are true to the best of
my knowledge.
Witness’s Signature: ___________________________ Date: _______________
Print Name: ___________________________
WITNESS 2
I, ___________________________, have no interest in the estate nor am I related to

the Decedent deceased. The statements made in this Affidavit are true to the best of
my knowledge.
Witness’s Signature: ___________________________ Date: _______________
Print Name: ___________________________

Estate Affidavit

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SMALL ESTATE AFFIDAVIT

AFFIDAVIT FOR THE COLLECTION OF PROPERTY

1. THE DECEDENT. This Small Estate Affidavit (“Affidavit”) made on

Decedent: __________________, who died on __________________,

2. THE AFFIANT. The name of the person preparing this Affidavit is

Description Value ($)

Description Value ($)

Heir’s Name: __________________ Relationship: __________________

Heir’s Name: __________________ Relationship: __________________

Heir’s Name: __________________ Relationship: __________________

8. TRANSFER OF PROPERTY. The following Heirs are entitled to the following

Property Heir’s Name

10. EXECUTION. This Affidavit is required to be signed under the requirements of

Affiant’s Signature: ___________________________ Date: _______________

Print Name: ___________________________

On, ___________________________, 20____ before me,

WITNESS my hand and official seal.

Print Name: ___________________________

I, ___________________________, have no interest in the estate nor am I related to

Witness’s Signature: ___________________________ Date: _______________

Print Name: ___________________________

I, ___________________________, have no interest in the estate nor am I related to

Witness’s Signature: ___________________________ Date: _______________

Print Name: ___________________________

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Heir’s Name: Relationship:

Heir’s Name: Relationship:

Heir’s Name: Relationship:

Affiant’s Signature: _____________ Date: _

On, _______________________, 20 before me,

Witness’s Signature: _____________ Date: _

Witness’s Signature: _____________ Date: _