Small Estate Affidavit
Affidavit for Collection of Property
I certify that all of the following statements are true in regards to the Estate of
__________________________________ who has deceased in the State of
____________________, County of __________________________________.
1. Decedent, __________________________________, died on the ____ day
of __________________________________, ____ in the County of
__________________________________, in the State of ______________.
2. A copy of the decedent’s death certificate will be submitted along with this
affidavit.
3. My name is __________________________________.
4. I reside at __________________________________ in the City of
__________________________________, in the State of ______________.
5. The value of the assets of the decedent’s estate exceeds the estate’s known
liabilities.
6. The value of the decedent’s estate does not exceed the monetary limit of
___________________ Dollars ($______________) imposed by the State of
______________.
7. I am either an heir of the decedent, and the decedent left no will, or I am a
named devisee of the decedent in the decedent’s will.
8. More than ___ days have passed since the decedent’s death.
9. There is no pending administration of the decedent’s estate.
10. There is no reasonable expectation that probate of the decedent’s estate is
soon to commence.
11. All heirs or devisees of the decedent are listed below:
Name
______________________

Address
___________________________________
Page 1 of 9

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name

Address

______________________

___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name

Address

______________________

___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Page 2 of 9

Relation ___________________ Telephone _____________________

Name

Address

______________________

___________________________________

Relation ___________________ Telephone _____________________
(If more Heirs or Devisees continue in Attachment A)
12. All heirs or devisees will be given notice of this affidavit within 30 days of
filing.
13. All assets of the decedent’s estate (whether real property or personal
property, whether community property or separate property) and the value of
such assets are listed below:
Asset

Value

Additional Information

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

(If more Assets continue in Attachment B)
14. All liabilities and debts of the decedent’s estate, and what the estate owes
each creditor, are listed below:
Liability/Debt
________________

Amount Owed

Creditor Information

$___________

__________________

Page 3 of 9

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

(If more Liabilities/Debts continue in Attachment C)
15. The following heirs or devisees are entitled to the following property:
Heir or Devisee

Property

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

(If more Liabilities/Debts continue in Attachment D)
16. This document is governed under the laws in the State of ______________.

Page 4 of 9

___________________________________________________
(Signature of the Affiant, the person preparing this affidavit)
Signed and sworn to me on the ___ day of __________________, in the year
20___.
State of _____________
County of _____________
I, the undersigned authority in and for said County in said State, hereby certify
that __________________, whose name is signed as the Affiant in this small
estate affidavit, and who is known to me, acknowledged before me on this day
that, being informed of the contents of the said document, (s)he executed the
same voluntarily on the day the same bears date.
Given under my hand this ___ day of _____________, 20___.
Notary Public Signature ____________________ State of _________________.
Printed Name: _____________________________.
My commission expires: _____________________
(Notary Seal)
Note: in addition, your State may require the affidavit and signatures of two (2)
disinterested witnesses.
WITNESS 1
I have no interest in the estate of ________________________, deceased, nor
am I related to the decedent. The statements made in this affidavit are true to
the best of my knowledge.
____________________________
(Disinterested Witness's signature)

________________________________
(Disinterested Witness’s printed name)

WITNESS 2
I have no interest in the estate of ________________________, deceased, nor
am I related to the decedent. The statements made in this affidavit are true to
the best of my knowledge.
____________________________
(Disinterested Witness's signature)

________________________________
(Disinterested Witness’s printed name)

Page 5 of 9

Attachment A
(Continued from Section 7)
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name

Address

______________________

___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________
Name
______________________

Address
___________________________________

Relation ___________________ Telephone _____________________

Page 6 of 9

Attachment B
(Continued from Section 13)
Asset

Value

Additional Information

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

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________________

$___________

__________________

________________

$___________

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________________

$___________

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________________

$___________

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________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________
Page 7 of 9

Attachment C
(Continued from Section 14)

Liability/Debt

Amount Owed

Creditor Information

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

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________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

________________

$___________

__________________

Page 8 of 9

Attachment D
(Continued from Section 15)
Heir or Devisee

Property

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

_____________________________________

_____________________

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_____________________

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_____________________

_____________________________________

_____________________

_____________________________________

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