Small Estate Affidavit Form
Download a blank fillable Small Estate Affidavit Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Small Estate Affidavit Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1S
E
A
MALL
STATE
FFIDAVIT
STATE OF: ________________________________________}
} SS
COUNTY OF: ______________________________________}
___________________________________residing at ________________________________________ being duly sworn,
deposes and says: _________________________________, insured under policy number___________________________
issued by ____________________________, died on date of _________________at ______________________________,
PLACE OF DEATH
leaving no will, and no petition for the appointment of a personal representative is pending or has been granted. Thirty (30)
days have elapsed since the death of the decedent, and the value of the entire estate does not exceed
________________________________________________________________ Dollars ($_________________________).
All funeral expenses and expenses of last illness of the decedent have been paid, except as follows:
___________________________________________________________________________________________________
And there are no unpaid debts of the decedent or decedent’s estate except as follows:
___________________________________________________________________________________________________
The following relatives of the decedent were surviving at the time of the decedent’s death:
RELATIONSHIP
NAME
AGE
RESIDENCE
SOCIAL SECURITY
Widow or widower: __________________________________________________________________________________
Children:___________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Children of deceased
children:____________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Other heirs:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
The names of heirs-at-law of the decedent are listed above and there are no others who could claim an interest in the estate.
We hereby agree to indemnify and hold harmless the _____________________________________________________
(Insurance Company)
from any and all costs, reasonable attorney fees, actions, loss or damage which it may suffer by virtue of payment to me
(us) under and because of the said policy of insurance.
____________________________________
(SIGNATURE OF AFFIANT)
____________________________________
(RELATIONSHIP TO THE DECEDENT)
Subscribed and sworn to before me this
_____Day of___________(Month),______(Year)
_____________________________
My Commission Expires: ___________________________________
(Notary Public)
ACF108 American Capital Funding, LLC.
Rev A, 4/12/01
Newport News, Virginia
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal