Small Estate Affidavit

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SMALL ESTATE AFFIDAVIT ($100,000 and under)
I, _______________________________, on oath state:
(name of affiant)
1. (a) My post office address is: _________________________________________________________
(b) My residence address is: __________________________________________________________
(c) I understand that, if I am an out-of-state resident, I submit myself to the jurisdiction of Illinois
courts for all matters related to the preparation and use of this affidavit. My agent for service of
process in Illinois is:
Name: _________________________________
Address: ______________________________
City: __________________________________
Phone (If any): _________________________
I understand that if no person is named above as my agent for service, or if for any reason, service on
the named person cannot be effectuated, the attorney who prepared this affidavit on my behalf is
recognized by Illinois law as my agent for service of process.
The decedent’s name is: __________________________________
The date of the decedent’s death was ___________________________, and I have attached a copy
of the death certificate hereto.
The decedent’s place of residence immediately before his death was:
No letters of office are now outstanding on the decedent’s estate and no petition for letters is
contemplated or pending in Illinois or in any other jurisdiction, to my knowledge.
The gross value of the decedent’s entire personal estate, including the value of all property passing
to any party either by intestacy or under a will, does not exceed $100,000. (Here, list each asset, e.g.
cash, stock, and its fair market value).
Name (Type of asset)
Amount and/or Description
All of the decedent’s debts including funeral expenses have been paid, or
The amount of the decedent’s debts including unpaid funeral expenses, and the name and
post office address of each person entitled thereto are as follows:
Person: __________________________________________
Amount __________________
Person: __________________________________________
Amount __________________
[Strike either 7(a) or 7 (b)]
171P-1 Rev.12/10
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