Form Dfs-Up-1243 - Estate Affidavit - Florida
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2ESTATE AFFIDAVIT
(FOR ESTATES WITH TOTAL VALUE OF UNCLAIMED
PROPERTY IN THE AMOUNT OF $5,000 OR LESS)
1. Deceased Owner’s Name (the “Decedent”): _______________________________________
2. Account Number(s): __________________
_________________ ___________________
Amount(s):
$__________________
$_________________ $___________________
3. Date of Deceased Owner’s Death: _____________________________
4. All funeral expenses, expenses of last illness, and all other lawful claims of Decedent’s estate have been
paid.
5. I am unaware of any dispute or potential conflict in regard to the estate and/or the will of Decedent.
6. I understand that I shall be personally liable for all lawful claims against the estate of the owner, equal to the
value of the property I receive. I also understand that I may be liable for attorney’s fees and legal costs if
any heir is found legally entitled to the property I receive pursuant to this affidavit.
7. Select either a) or b):
_____ a) The Decedent left no will. No probate proceedings are pending in regard to Decedent’s estate. All
heirs have amicably agreed upon a division of the estate. Select one of the following:
_____(1) The heirs are the direct descendants of the decedent.
_____(2) There are no direct descendants of the decedent. The heirs are the decedent's father and
mother, or the surviving father or mother.
_____(3) The decedent has no direct heirs nor surviving parents. The heirs are the decedent's brothers
and sisters or the direct descendants of the deceased brothers and sisters.
_____(4) Other relationship. Please specify: _______________________________________________
All persons, who are listed as being entitled to the Decedent’s estate before me under the intestacy laws of the
state in which the Decedent resided at the time of death, are deceased.
The names and addresses of Decedent’s heirs and, the portion of the estate agreed upon by each heir, and the
relationship of each heir to the Decedent are as identified on the second page of this estate affidavit.
_____ b) The Decedent left a will. No probate proceedings are pending in regard to Decedent’s estate. An
unaltered copy of this will is attached. To the best of my knowledge and belief, this will is Decedent’s last will
which was signed by the Decedent and the attesting witnesses as required by law, and would be admitted to
probate. The names and addresses of the beneficiaries, the portion of the estate, if any, to which each is entitled
in accordance with the will, are identified on the second page of this estate affidavit.
8. Complete and sign the second page of this Estate Affidavit and attach the proof of identification as required
on the claim form.
Form DFS-UP-1243, Revised 01/03/2005
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