Fillable Printable Virginia Small Estate Act Affidavit

Virginia Small Estate Act Affidavit

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VIRGINIA SM ALL ESTATE ACT AFFIDAVIT

Va. Code §64.2-600 & 601

Note to the “Person” to whom this Affidavit is delivered: Any person having possession of a small asset shall pay or

deliver the small asset to the designated successor of the decedent upon being presented an affidav it made by all of the

known successors. If you do not understand or have questions regarding your legal responsibilities relative to this

Affidavit, you should consult an attorney at law. “Person" means any individual, corporation, business trust, fiduciary,

estate, trust, partnership, limited liability company, association, joint venture, government, governmental subdivision,

agency, or instrumentality, public corporation, or any other legal or commercial entity.

I/WE, the “Successor(s)”

___________________________________________________________________________________, after being

first duly sworn, depose and state as follows:

1. That ________________________________________, the “Decedent”, died on the _______ day of

_________________, 20_____.

2. That at the time of death, the Decedent’s estate consisted only of a “Small Asset”. "Small asset" means any

indebtedness owed to or any asset belonging or presently distributable to the de cedent, other than real property,

having a value, on the date of the decedent's death, of no more than $50,000. A small asset includes any bank account,

savings institution account, credit union account, brokerage account, security, deposit, tax refund, overpayment, item

of tangible personal property, or an instrument evidencing a debt, obligation, stock, or chose in action. Upon

presentation of this affidavit, the designated successor may endorse, or negotiate any small asset that is a check, draft,

or other negotiable instrument that is payable to the decedent or the decedent’s estate.

A description of the Small Asset appea rs below:

Bank Account Savings Institution Account Credit Union Account Brokerage Account Security

Deposit

Tax Refund Overpayment Tangible Personal Property Instrument Evidencing a Debt (i.e.

promissory note)

Obligation (i.e. a contract right) Stock Chose in Action (i.e. right to sue)Description of

Small Asset (if required by recipient of Affidavit)

_____________________________________________________________________________________________

3. That the value of Decedent’s entire personal probate estate as of the date of the decedent’s death, wherever located,

does not exceed $50,000.00.

4. That at least 60 days have elapse d since the Decedent’s death.

5. That no application for the appointment of a personal representative is pending or has been granted in any

jurisdiction.

6. That the Decedent’s will, if any, was duly probated.

7. That the claiming Successor is entitled to payment or delivery of the small asset and the basis upon which such

entitlement is claimed appears below (check all that apply):

"Successor" means any person, other than a creditor, who is entitled under the decedent's will or the laws of intestacy

to part or all of a small asset.

Surviving Spouse Beneficiary under Will He ir (no Wi ll ) Other

If Other, describe relationship to the Decedent: _________________________________

8. The names and addresses of all Successors, to the extent known, are:

________________________________________________________________________________________________

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(IF MORE SPACE IS NEEDED, ATTACH ADDITIONAL PAGE(S) TO AFFIDAVIT)

9. The name of each successor designated to receive payment or delivery of the small asset on behalf of all successors

is/are:

“Designated Successor” means one or more successors who are designated pursuant to subdivision A 7 of § 64.2-60 to

receive payment or delivery of the small asset on behalf of all successors.

________________________________________________________________________________________________

10. That the Desi gnated Successor shall ha ve a fiduciary duty to safeguard and promptly pay or deliver the small asset

as required by the laws of the Commonwealth.

WHEREFORE, the undersigned Successor(s) to the Small Asset of the Decedent, make this Affidavit pursuant to Va.

Code § 64.2-601.

(ALL SUCCESSORS MUST SIGN BELOW)

Signature Signature

(IF MORE SPACE IS NEEDED, ATTACH ADDIT IONAL PAGE(S) TO AFFIDAVIT)

STATE OF ___________________, City/County of ____________________, to-wit:

This Virginia Small Estate Act Affidavit was acknowledged, subscribed and sworn to be fore me this ________ day of

_______________, 20_____, by

________________________________________________________________________

My Commission expires: _______________.

Notary Registration number: ______________________.

NOTARY SEAL

_________________________________________

NOTARY PUBLIC

ADD AS MANY NOTARY ACKNOWLEDGEMENTS AS NEEDED