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Small Estate Affidavit Form

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Small Estate Affidavit

AFSE (4-15)

UNITED STATES OF AMERICA

STATE OF ILLINOIS

COUNTY OF LASALLE

IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT

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 ___________________________________________________________________

Telephone (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 Clerk of the Circuit Court of LaSalle County, 13th Judicial Circuit, Illinois 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.)

7. (a) All of the decedent's funeral expenses and other debts, have been paid, or

(b) All of the decedent's known unpaid debts are listed and classified as follows (include the name, post office address and

amount):

Strike either 7(a) or 7(b)

LASALLE COUNTY CIRCUIT CLERK OTTAWA, ILLINOIS 61350

Small Estate Affidavit Form

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