Small Estate Affidavit Form - Circuit Court Of Cook County, Illinois Page 2
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4Small Estate Affidavit
(04/28/15) CCP N608 B
Class 3: debts due the United States, as follows:
Name and 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, as follows:
Name and Post Office Address
Amount
Class 5: money and property received or held in trust by the decedent which cannot be identified or
traced, as follows:
Name and 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, as follows:
Name and Post Office Address
Amount
Class 7: all other claims, as follows:
Name and 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 insuffi-
cient 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 child(ren) and adult dependent*
child(ren) of the decedent are as follows:
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
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