Small Estate Affidavit Form Page 3

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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 penalties 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

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