Small Estate Affidavit Form - Circuit Court Of Cook County, Illinois Page 4
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4Small Estate Affidavit
(04/28/15) CCP N608 D
recovery.
11.
After payment by me from the decedent’s estate of all debts and expenses listed in paragraph 7, any re-
maining property described in paragraph 6 of this affidavit should be distributed as follows:
Name
Specific Sum or Property to be Distributed
The foregoing statement is made under the penalties of perjury*.
___________________________________
Signature of Affiant
Signed and sworn before me on ________________________, 20________
(Notary Seal)
___________________________________
Notary Public
*(Note: A fraudulent statement made under the penalties of perjury is perjury, as defined in Section 32-2 of the Criminal
Code of 2012.)
(c) Appointment of Agent. If safe deposit access is involved or if sale of any personal property is desirable to facilitate distribution pursu-
ant to the small estate affidavit, the affiant under the small estate affidavit may in writing appoint one or more persons as the affiant’s agent
for that purpose. The agent shall have power, without court approval, to gain access to sell, and distribute the property in the manner speci-
fied in paragraphs 7.5 and 11 of the affidavit; and the payment, delivery, transfer, access or issuance shall be made or granted to or on the
order of the agent. The affiant may appoint himself or herself as the designated representative to exercise the powers and perform the duties
of an agent described in this subsection (c).
(d) Reliance and Release. Any person, corporation, or financial institution who acts in good faith reliance on a copy of a document
purporting to be a small estate affidavit that is substantially in compliance with subsection (b) of the Section shall be fully protected and
released upon payment, delivery, transfer, access or issuance pursuant to such a document to the same extent as if the payment, delivery,
transfer, access or issuance had been made or granted to the representative of the estate. Such person, corporation, or financial institution is
not required to see to the application or disposition of the property; but each person to whom a payment, delivery, transfer, access or issu-
ance is made or given is answerable therefor to any person having a prior right and is accountable to any representative of the estate.
(e) Distributions pursuant to an affidavit substantially in the form set forth in subsection (b) of the Section may be made to the affiant, if
so specified in paragraph 11, notwithstanding the disclosure of known unpaid debts. The affiant, acting on behalf of the decedent’s estate,
is obligated to pay all valid claims against the decedent’s estate before any distribution is made to any heir or legatee. The affiant signing the
small estate affidavit prepared pursuant to subsection (b) of this Section shall indemnify and hold harmless all creditors, heirs, and legatees
of the decedent and other persons, corporations, or financial institutions relying upon the affidavit who incur loss because of such reliance.
That indemnification shall only be up to the amount lost because of the act or omission of the affiant. Any person, corporation, or financial
institution recovering under this subsection (e) shall be entitled to reasonable attorney’s fees and the expenses of recovery.
(f ) The affiant of a small estate affidavit who is a non-resident of Illinois submits himself or herself to the jurisdiction of Illinois courts for
all matters related to the preparation or use of the affidavit. The affidavit shall provide the name, address, and phone number of a person
whom the affiant names as his agent for service of process. If no such person is named or if, for any reason, service on the named person
cannot be effectuated, the clerk of the circuit court of the county or judicial circuit of which the decedent was a resident at the time of his
death shall be the agent for service of process.
(g) Any action properly taken under this Section, as amended by Public Act 93-877, on or after August 6, 2004 (the effective date of Pub-
lic Act 93-877) is valid regardless of the date of death of the decedent.
(h) The changes made by this amendatory Act of the 96th General Assembly apply to a decedent whose date of death is on or after the ef-
fective date of this amendatory Act of the 96th General Assembly.
(i) The changes made by this amendatory Act of the 98th General Assembly apply to a decedent whose date of death is on or after the ef-
fective date of this amendatory Act of the 98th General Assembly.
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Page 4 of 4
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