Fillable Small Estate Affidavit Form (Page 2 of 3) in pdf

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.

There is no known unpaid claimant or contested claim against the decedent except as stated in paragraph 7.

(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

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

Small Estate Affidavit Form Page 2

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