Small Estate Affidavit Form - Circuit Court Of Cook County, Illinois Page 3
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4Small Estate Affidavit
(04/28/15) CCP N608 C
Name and Relationship
Place of Residence
Age of Minor Child
(*Note: An adult dependent child is one who is unable to maintain him/herself and is likely to become a 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 decedent’s death. If any such child(ren) did not reside
with the surviving spouse at the time of the decedent’s death, so indicate.)
(c) If there is no surviving spouse, the award allowable to 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. (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
Age of
Portion of
and Place of Residence
Minor
Estate
OR
(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 admis-
sible 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
Age of
Portion of
and Place of Residence
Minor
Estate
Strike either 10(a) or 10(b).
(c) Affiant is unaware of any dispute or potential conflict as to the heirship or will of the decedent.
10.3
My relationship to the decedent or the decedent’s estate is as follows: ___________________________.
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
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
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