Small Estate Affidavit Form Page 2
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4Class 1: Funeral and burial expenses, which include reasonable amounts paid for a burial space, crypt, or niche; a marker on
the burial space; and care of the burial space, crypt, or niche; expenses of administration; and statutory custodial claims as
follows:
Name and Post Office Address
Amount
Class 2: The surviving spouse's award or child's award, if applicable, as follows:
Name and Post Office Address
Amount
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 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
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