Fillable Printable Small Estate Affidavit Form - Illinois
Fillable Printable Small Estate Affidavit Form - Illinois
Small Estate Affidavit Form - Illinois
AN AFFIDAVIT TO JESSE WHITE, THE SECRETARY OF THE STATE OF ILLINOIS, PURSUANT TO 755 ILCS 5/ART. XXV
OF
THE PROBATE ACT,
ILLINOIS
COMPILED STATUTES, AS AMENDED BY PUBLIC ACT 9 8 - 0 836 (EFF. 1-1-15
)
.
STATE
OF
ILLINOIS
COUNTY OF ________________________
SMALL ESTATE
AFFIDAVIT
I,
(name of affiant), on oath
state:
1.
(a)
My
pos
t
offic
e
address
is:
(b) My residence address
is:_______________________________________________________________________________; and
(c) I understand that
if
I
am an out-of-state resident
I
submit myself to the jurisdiction of Illinois courts for all matters related
to
the
preparation and use of this affidavit. My agent for service of process in Illinois
is:
NAME:
ADDRESS:
CITY:
TELEPHONE:
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) ___________________________________
(Judicial
Circuit
)
Illinois is
recognized
by Illinois 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/her 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
Illinois 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
$100,000
in value and consists of the
following (list each asset and its fair market value):
Including vehicle(s) described below:
Make
of Vehicle
Body Type
Year
Model Vehicle
Identificatio
n
N
umber
Make of Vehicle Body Type
Year
Model
Vehicle
Identificatio
n
Number
Last licensed in the State of Illinois in (Year) __________ License Plate Number(s)_______________________________________________
7. Mark (X) either (a) or (b): (a) All the decedent's funeral expenses and other debts have been paid, or (b) A ll t he
decedent's known
unpaid debts are listed and classified as follows
:
Class 1: Funeral and burial expenses, which include reasonable amounts paid for a burial space, crypt, or niche; a marker on the
burial space; and care of the burial space, crypt, or niche; expenses of administration; and statutory custodial claims:
Name
Post Office Address________________________________________________________Amount $_______________________________
Class 2: Surviving spouse’s award or child’s award, if applicable:
Name
Post Office Address________________________________________________________Amount $_______________________________
Class 3: Debts due the United States:
Name
Post Office Address________________________________________________________Amount $_______________________________
Class 4: Money due employees of the decedent of not more than $800 for each claimant for services rendered within four (4) months prior
to the decedent’s death and expenses attending the last illness:
Name
Post Office Address________________________________________________________Amount $_______________________________
Class 5: Money and property received or held in trust by the decedent that cannot be identified or traced:
Name
Post Office Address________________________________________________________Amount $_______________________________
Class 6: Debts due the State of Illinois and any county, township, city, town, village, or school district located within Illinois:
Name
Post Office Address________________________________________________________Amount $_______________________________
Class 7: All other claims:
Name
Post Office Address________________________________________________________Amount $_______________________________
7.5 I understand that all valid claims against the decedent’s estate described in paragraph 7 must be paid by me from the decedent’s estate
before any distribution is made to any heir or legatee. I further understand that the decedent’s estate should pay all claims in the order set
forth above, and if the decedent’s estate is insufficient to pay the claims in any one class, the claims in that class shall be paid pro rata.
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 Relationship Place of Residence
Age of Minor
Child
*(Note: An adult dependent child is one who is unable to maintain himself and is likely to become a public
charge.
)
(b) The award
allowable
to the surviving spouse of a
decedent
who was an Illinois resident is $
($20,000, plus $10,000 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
decedent's
death, so indicate in 9(a)}.
(c) If there is no
surviving
spouse, the award allowable to the minor children and adult
dependent children
of a
decedent
who
was
an
Illinois
resident is $ ($20,000, plus
$10,000
multiplied by
the
number of minor children and adult
dependent
children),
to be
divided
among them in equal
shares.
10. Mark (X) either 10(a) or
10(b)
:
(a) The decedent left no will. The names, places of residence and relationships of the decedent's heirs, and the portion of the estate
to which each heir is entitled under the law where decedent died intestate are as follows:
Name,
Relationship and Place of
Residence Age of Minor Portion of Estate
(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 admittable 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 and Place of Residence Age of Minor Portion of
Estate
(c) Affiant is unaware of any dispute or potential conflict as to the heirship or will of the decedent.
10.3 My relationship to the decedent or the decedent’s estate is:_____________________________________________________________.
10.5 I understand that the decedent’s estate must be distributed first to satisfy claims against
the decedent’s estate as set forth in paragraph 7.5 of this affidavit before any distribution is
made to any heir or legatee. By signing this affidavit, I agree to indemnify and hold harmless all
creditors of the decedent’s estate, the decedent’s heirs and legatees, and other persons,
corporations, or financial institutions relying upon this affidavit who incur any loss because of
reliance on this affidavit, up to the amount lost because of any act or omission by me. I further
understand that any person, corporation, or financial institution recovering under this
indemnification provision shall be entitled to reasonable attorney’s fees and the expenses of
recovery.
11. After payment by me from the decedent’s estate of all debts and expenses listed in paragraph 7, any remaining property described in
paragraph 6 of this affidavit should be transferred to (NAME)_________________________________________________________________
(ADDRESS)________________________________________________________________________________________________________;
this affidavit is made to induce Jesse White, Secretary of State of Illinois, to issue a Certificate of Title to the vehicle to the
assignee.
The
foregoing
statement
is
made under the
penaltie
s
of
perjury. (Note: A
fraudulent
statement made under the penalties of
perjury
is
perjury, as defined In
Section
32-2 of the
Criminal
Code of 2012.)
____________________________________________________________________
Signature of Affiant Date
Subscribed and sworn to before me this _________________________ day of ____________________________, ___________.
_____________________________________________________________________
Notary Public (SEAL)
Printed by authority of the State of Illinois. January 2015 – 1 – RT OPR 31.16
