Small Estate Affidavit Template

This Small Estate Affidavit (the “Affidavit”) is made on [Date] by:

Affiant (Claimant): [Full Name], address: [Address], phone/email: [Contact] (“Affiant”).

Decedent: [Full Legal Name] (the “Decedent”)
Date of Death: [Date]
County/State of Death: [County/State]
Last Address: [Address]

1. Purpose

1.1 I am making this Affidavit to claim and/or transfer certain assets of the Decedent under applicable small estate procedures, where permitted.

2. Eligibility Statements (Customize to Your State)

2.1 Waiting Period: At least [__] days have passed since the Decedent’s date of death (if required).
2.2 No Probate: No petition for the appointment of a personal representative/executor is currently pending or has been granted, or if it has, this Affidavit is allowed by law: ☐ Yes ☐ No (explain).
2.3 Estate Value: To the best of my knowledge, the total value of the Decedent’s probate estate subject to this procedure does not exceed the applicable statutory limit in [State]: $[Limit] (or “as defined by law”).
2.4 No Known Disputes: There are no known disputes among heirs/successors regarding the property described below, except: [Explain].

3. Relationship and Successor Information

3.1 My relationship to the Decedent is: ☐ spouse ☐ child ☐ parent ☐ sibling ☐ other: [Explain].
3.2 The Decedent’s successors/heirs are (attach additional page if needed):

• [Heir Name], relationship: [], address: [], share: [__]%

• [Heir Name], relationship: [], address: [], share: [__]%

3.3 Will (If Any):
☐ The Decedent left a will dated [Date]. A copy is attached.
☐ No will is known to exist.

4. Assets Being Claimed

4.1 I request transfer/payment of the following assets (attach supporting statements if available):

• Asset #1: [Bank/Institution], account/asset ID: [], estimated value: $[]

• Asset #2: [Vehicle], VIN: [], estimated value: $[]

• Asset #3: [Personal property], description: [], estimated value: $[]

4.2 Total Estimated Value of Listed Assets: $[Total].

5. Debts, Expenses, and Claims

5.1 Known debts/expenses of the Decedent include: [List].
5.2 Funeral/burial expenses: ☐ paid ☐ unpaid. Amount: $[__].
5.3 I agree to use received assets to pay lawful debts and expenses as required.

6. Indemnification

6.1 I agree to indemnify and hold harmless any person or institution that transfers property to me in reliance on this Affidavit from any claims by other heirs or creditors, except as prohibited by law.

7. Supporting Documents (Attach as Available)

7.1 ☐ Certified death certificate
7.2 ☐ Copy of will (if any)
7.3 ☐ Proof of identity
7.4 ☐ Asset statements (bank/vehicle title)
7.5 ☐ Heirship documentation (if required)
7.6 ☐ Other: [List]

8. Statement Under Oath

8.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.

Signatures

Affiant: [Full Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (If Required)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________